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Homeless people cultivate food, better health while gardening in Alameda County

CalFresh Healthy Living, UCCE Alameda gets residents of South County Homeless Project involved in growing their own food.

Fresh fruits and vegetables are essential to a healthful diet, but it's hard to keep perishable foods on hand if one doesn't have a refrigerator or a home. To enhance the health of homeless people, the CalFresh Healthy Living, UC Cooperative Extension team in Alameda County has partnered with the South County Homeless Project to grow fresh produce for people staying at the emergency housing in Hayward.

For the past seven years, CalFresh Healthy Living, UCCE Alameda has been delivering nutrition lessons to residents of the South County Homeless Project, part of Building Opportunities for Self Sufficiency. The classes include Rethink Your Drink, Food Safety, Making Every Dollar Count, Eat Healthy Be Active Community Workshops, and Fresh from the Garden.

The neglected flower garden behind the South County Homeless Project facility was converted into an edible garden. Photo by Tuline Baykal

The South County Homeless Project facility houses 24 people for up to a year. With the help of the CalFresh Healthy Living, UC Cooperative Extension team, its existing garden was refurbished and redesigned. The large outdoor garden behind the facility offers therapeutic gardening opportunities to residents and provides food for their meals. 

"I love the garden and when the cook cooks the vegetables, they taste amazing,” said one resident. “I am thankful for this garden and for having the CalFresh Healthy Living team.”

At one time, South County Homeless Project's backyard featured a flower garden. After years of neglect, weeds overtook the garden.

In 2022, CalFresh Healthy Living, UCCE Alameda proposed getting residents involved in growing food by resurrecting the garden with edible plants.

“Not only could we continue to engage residents in nutrition education classes, but we could also work together to reinvigorate their neglected garden,” said MaxFairbee, nutrition educator withCalFresh Healthy Living team,UCCE Alameda.

With help from UC Master Gardeners of Alameda County volunteers, the CalFresh Healthy Living, UCCE staff and residents converted the neglected flower garden behind the South County Homeless Project facility into an edible garden. Photo by Tuline Baykal

More than 15 varieties of herbs and vegetables planted

Residents and staff set out to replace the weedy beds with a vegetable and herb garden.

“We worked with South County staff and residents on the design, clean up, planting, harvesting and ultimately incorporating food from the garden into the kitchen for residents to enjoy the fruits of their labor,” Fairbee said.

For gardening expertise and support, Fairbee enlisted the UC Master Gardeners of Alameda County's Community Garden Team to help. While the CalFresh Healthy Living, UCCE staff continued providing nutrition classes, the UC Master Gardener volunteers trained the residents on the basics of gardening.

In April, after heavy rains, the group planted 50 seedlings, half donated by the UC Master Gardeners. They planted two varieties of lettuce,arugula, four varieties of tomatoes, zucchini, kale, onions, cucumbers, green beans, Swiss chard, kale, basil, cilantro, tarragon, thyme, parsley, rosemary, oregano and mint.

Fairbee hopes that after leaving the South County Homeless Project residents will continue gardening to grow fresh vegetables for a nutritious diet and better health. Photo by Max Fairbee

From garden to table

“In May, we harvested lettuce and in June, we harvested green beans, cucumbers, kale and onions,” Fairbee said.

The fresh vegetables and herbs were used to prepare salads, sandwiches and pasta dishes for the residents. Fairbee and the other educators have also used the fresh produce for cooking demonstrations and tastings as part of their Fresh from the Garden class.

"We have been able to use many of the veggies as sides or to go in the salad," said one of the South County Homeless Project cooks.

"One of the chefs used the zucchini in the pasta sauce, it was so good! I didn't really know you could use it that way!" said a resident.

After tasting summer squash andgazpacho made with tomatoes from the garden, a South County resident namedSelina said, "I was surprised how good the raw summer squash tasted and how the flavor was different after it was cooked. I'll definitely be adding more zucchini to my plate."

Adding picnic tables and benches to the garden gives staff and residents a peaceful place to relax. Photo by Max Fairbee

Challenges to keeping the garden going

To keep the garden healthy, they faced competition with plant-chewing snails, slugs and aphids and cats digging in the soil. Because the water source is over 200 feet from the garden, they run a long hose across the main path, along the parking lot to water the plants, then unhook the hose and stash it indoors after each use so that it won't get stolen.

Another challenge of maintaining the garden is getting enough residents and staff to volunteer to work on it.

“Although staff are supportive of the garden, none actually have time to work in the garden,” Fairbee said.

The residents harvest, wash and store the produce in the kitchen. Only four to six of the 24 residents are typically interested in working in the garden, pulling weeds and protecting the plants from pests – most are focused on getting a new job and a home. South County residents usually leave the temporary housing within a few months.

For more consistent garden maintenance, Fairbee is looking to other community groups for volunteers. He is also hoping to persuade the county government to install a water spigot close to the garden so they can install drip irrigation to water the garden.

“We'd like to work with the UC Master Food Preservers to teach residents how to preserve herbs and vegetables,” Fairbee said.

He hopes South County Homeless Project residents will continue gardening in their new homes to grow fresh vegetables so they can enjoy a more nutritious diet and better health.

Beyond the fresh food, the South County Homeless Project residents and staff enjoy the ambience of the garden.

"It's really nice to go back there and just sit, it's really peaceful," said one staff member.

A resident added, "(The garden) relaxes me from stress. I love the garden."

Posted on Thursday, April 4, 2024 at 3:16 PM
Focus Area Tags: Food, Health

Organic strawberry yields boosted by technique refined through UCCE research

There is a stark difference in plant vigor between an ASD-treated plot (left) and a standard untreated plot in an organic field infected with charcoal rot. Photo by Joji Muramoto

Anaerobic soil disinfestation helps suppress weeds, disease without fumigants

Troubled by puny plants, low yields and persistent mite problems, third-generation Southern California strawberry grower Glen Hasegawa was ready to give up on his transition from conventional to organic 12 years ago.

“I've always liked a challenge – but it turned out to be more of a challenge than I thought it would be!” he said.

But then, with the help of scientists including Oleg Daugovish, UC Cooperative Extension strawberry and vegetable crop advisor in Ventura County, Hasegawa tried a technique called anaerobic soil disinfestation (ASD). When applied correctly, the multi-step ASD process creates a soil environment that suppresses pathogens and weeds and makes for healthier, more robust crop growth.

“Back in the day, it was really hard to get the plant growing vigorously in organic,” said Hasegawa, owner of Faria Farms in Oxnard. “So we started using the ASD and then you could definitely see that the plant had more vigor and you could grow a bigger, better plant using it.”

Seeing that he could produce yields “in the neighborhood” of those grown in conventional strawberry fields fumigated with synthetic fumigants, Hasegawa was able to expand his original 10 acres of organic strawberries to 50 acres.

“I guess you could say I'm kind of a convert,” he said, noting that he now applies ASD to all his acreage each year in late spring.

Joji Muramoto, UC Cooperative Extension specialist in organic production based at UC Santa Cruz, has been experimenting with ASD since it was first brought to the U.S. from the Netherlands and Japan in the early 2000s. Carol Shennan, a professor in the Department of Environmental Studies at UCSC, and Muramoto were among the first to try the technique in California. They found that ASD successfully controlled an outbreak of Verticillium wilt – caused by the pathogen Verticillium dahliae – at UCSC's small organic farm in 2002.

Since then, Shennan, Muramoto, Daugovish and their colleagues have seen encouraging results at 10 trial sites across the state.

“We demonstrated that ASD can provide comparable yields with fumigants, in side-by-side replicated trials,” Muramoto said.

The strawberry plants in the ASD-treated plot (left) are more robust than those growing in untreated soil. A plastic mulch (typically opaque is used by growers, but clear was used here for research purposes) is crucial as part of the ASD process to improve plant productivity and control weeds. Photo by Oleg Daugovish

ASD promotes host of beneficial changes to soil ecosystem

ASD comprises three basic steps: incorporating a carbon source that is easily digestible by microbes in the soil (traditionally, rice bran has been used), further encouraging fermentation by covering the soil with plastic to limit oxygen supply, and finally adding water through drip irrigation to initiate the “anaerobic” decomposition of the carbon source and maintain the three-week “cooking” process.

The resulting cascade of chemical, microbiological and physical changes to the soil creates an ecosystem that is both conducive to strawberry growth – and inhospitable to pathogens and weeds.

“It's not like a pesticide where you have a mode of action, and thus resulting in ‘A' and ‘B' for you,” Daugovish explained. “There's a sort of cocktail of events that happens in the soil; they all happen interconnectedly.”

Compared to similar fields that did not undergo the process, ASD-applied organic strawberry fields across California have seen yields increase by 60% to 70% – and even doubling in some cases, according to Daugovish.

The UCCE advisor also shared the story of a longtime grower in Ventura County, who came to him with fields in “miserable” condition; they were plagued by one of the world's worst weeds, yellow nutsedge, and infected with charcoal rot, a disease caused by the fungus Macrophomina phaseolina. But after applying rice bran and following the ASD recipe, the grower saw phenomenal results.

“The only complaint he said to me was, ‘Now I have too many berries – we have to have more pickers to pick the berries!'” Daugovish recalled.

Via researchers' meetings, online resources, on-farm demonstration trials and word of mouth from peers, use of ASD by California strawberry growers has grown significantly during the past two decades. Tracking the purchase of rice bran, Muramoto estimated that about 2,500 acres were treated by the ASD-related practices in 2023 – covering roughly half of the 5,200 total acres of organic strawberries in California.

Muramoto directly links the growth of California organic strawberry production – which now comprises about 13% of total strawberry acreage in the state – with the increasing adoption of ASD.

“If you remove the acreage with the applied rice bran over the last 10 years or so, organic strawberry acreage is just flat,” he said.

Applying rice bran provides the easily digestible carbon source that soil microbes feed on. Once covered by plastic mulch, anaerobic conditions develop and microorganisms that prefer such an environment thrive, while pathogenic organisms and germinating weeds are suppressed. Before planting, holes are cut in the plastic to let oxygen back into the soil and encourage the growth of the strawberry plants. Photo by Oleg Daugovish

Within the last decade, acreage of organic strawberries with ASD-related practices increased by 1,640 acres, which is a boon for air quality, human health and long-term soil vitality. According to Muramoto's calculations, that increase in organic acreage translates to a reduction of about 465,000 pounds of fumigant active ingredients that would have been used in growing conventional strawberries.

“There are hundreds of reports of acute illnesses related to fumigation in the record, so it's very important to find alternatives to fumigants,” said Muramoto, citing California Department of Pesticide Regulation documents.

Research continues to make ASD more economical, effective

The popularity of ASD has come at a price, however, for organic strawberry growers.

“There's more organic out there, and I think most of the organic guys are using it, so there's more demand on the rice bran; the price has been steadily going up every year, like everything else,” said Hasegawa, adding that he has been trying to decrease the amount of carbon while maintaining ASD's efficacy.

On top of greater demand from other growers and from beef cattle and dairy producers (who use rice bran as feed), the price also has increased due to higher costs in transporting the material across the state from the Sacramento Valley. So Daugovish and his colleagues – including Peter Henry, a U.S. Department of Agriculture plant pathologist – have been searching for a cheaper alternative.

“We all want an inexpensive, locally available, reliable, easy to use and functional carbon source, which sounds like a big wish list,” Daugovish said.

Carbon sources such as bark, wood chips, or compost are ineffective, as the crucial ASD microorganisms are choosy about their food.

In a field of 'Victor' strawberries, researchers saw a 41% increase in yield using ASD with midds, in comparison to untreated soil. Photo by Oleg Daugovish

“Microbes are just like cows; you can't feed them straight wood; they get pretty angry,” Daugovish explained. “And if you feed them something with too much nitrogen, they can't digest it – they get the runs. Microbes are the same way – you have to have the right proportion of stuff so they feel comfortable doing what they're doing.”

In search of an ideal replacement, researchers tried and ruled out grass clippings, onion waste, glycerin and coffee grounds. Finally, they pivoted to a material with properties very similar to rice bran: wheat bran, in the form of wheat middlings (also called midds, a byproduct of flour milling) and dried distillers' grain (DDG, a byproduct of ethanol extraction).

After field experiments in Santa Paula, the UC and USDA researchers found that midds and DDG were just as effective at controlling soilborne pathogens and weeds as rice brain – but at 25% to 30% less cost. Their results were published last year in the journal Agronomy.

“Not surprisingly, the wheat bran has worked almost exactly the same as rice bran,” Daugovish said.

He and Muramoto are now conducting trials with wheat bran at commercial fields, and the initial results are promising. Daugovish said the grower at one site in Ventura County has seen a 90% reduction in Macrophomina phaseolina, the causal pathogen of charcoal rot, in the soil – and an 80% to 90% drop in yellow nutsedge germination. They are waiting for final yield numbers after the coming summer.

While ASD has been beneficial to organic productivity and soil health, both Daugovish and Muramoto acknowledged specific limitations in suppressing the “big three” strawberry diseases: Verticillium wilt, Fusarium wilt and charcoal rot. In coastal areas with cooler soil temperatures, for example, ASD can actually exacerbate the latter two diseases, as the fungal pathogens feed on the rice bran.

“We know it works at warmer temperatures, but, practically, it's hard to do in coastal California,” Muramoto said. “It would be nice if we can find a way to suppress Fusarium wilt at a lower temperature, but we don't have it right now.”

That's why researchers emphasize that ASD is not a “silver bullet.” It's just one tool in the organic toolbox, which includes careful crop rotation, disease-resistant strawberry varieties and better diagnostic tests that help growers pinpoint outbreaks and make the application of various methods more targeted and more efficient.

And scientists will continue to optimize ASD to make it more effective and economical for growers in the different strawberry regions of California – from the Central Coast to the Oxnard Plain.

“We know it can work really well; it's just finding the most sustainable way to do this in our region,” Daugovish said. “We've got to just have an open mind and keep trying.”

Posted on Tuesday, March 19, 2024 at 6:40 AM
Focus Area Tags: Agriculture, Environment, Food, Innovation

Study: Government shutdown stressed food assistance program participants

Uncertainty caused by a government shutdown adds to the stress of people grappling with food insecurity. Photo by Evett Kilmartin

A U.S. federal government shutdown can represent a minor inconvenience, a delay in paychecks, or – for people living in some of the most difficult circumstances – an extended period of hunger and anxiety.

A study published recently in the journal Nutrients provides a unique glimpse into the shutdown experiences of participants in CalFresh – California's name for the federally funded Supplemental Nutrition Assistance Program (formerly known as food stamps). Currently, about 42 million people participate in SNAP across the U.S.

In focus groups conducted in 2019 with 26 low-income CalFresh participants from four diverse California counties, participants shared how the 2018-19 federal government shutdown affected their SNAP benefits, their perception of the program and their faith in government.

One of the immediate effects of the 2018-19 shutdown was that February CalFresh benefits were distributed in January. And while that meant program participants saw extra benefits that month, they then had to wait 40 to 44 days until the March issuance – much longer than the usual 28 to 31 day cycle.

“What we saw with this study is that this extended lag in benefit receipt from January to March was devastating,” said Wendi Gosliner, senior researcher and policy advisor at the Nutrition Policy Institute of UC Agriculture and Natural Resources, and an author of the study funded by UC ANR.

She recalled one participant who, despite having a gastrointestinal issue that requires a special diet, had to eat canned food from the food bank that made her sick – rather than go hungry while waiting for her March benefits. Others described cascading financial challenges after using rent money for food in February, or going into debt to pay for food and getting behind on other expenses.

The study also chronicles the experiences of a woman who was anguished to hear the suffering of her daughter, also a CalFresh participant: “She called me several times crying, ‘Ma, I don't – we don't have enough food. What am I going to do…? You know, I can't afford to this and this and this.' And I can't help her.”

For individuals grappling with food insecurity, the stress of feeding their families was compounded by the uncertainties of the government shutdown. And while many participants exercised their agency and resourcefulness in coping with the situation, they also felt a degree of powerlessness amid the “confusion and craziness,” as one person put it.

“No one knew how long that shutdown was going to last; no one knew if the March benefits were going to be paid,” Gosliner said. “And as we learned, there were all kinds of stories circulating out there about what was going on with the uncertainty – a lot of people didn't have the information about what was actually happening.”

Some participants, seeing the “double benefit” in January 2019, thought that it was the last-ever distribution and that SNAP was ending. Others described being unable to get in touch with the CalFresh agency to get their questions answered about the benefits. Most participants had not heard about the disrupted benefit schedule before receiving the benefits. As a result, many people in the focus groups shared that their overall faith in government had been shaken.

Improving customer service, boosting benefit levels and adjusting eligibility and benefit formulas to reflect high cost-of-living and expenses related to working were three recommendations that came from the focus group participants.

A fourth recommendation tackles the shutdown issue head-on: Don't let it happen again.

“Congress should do absolutely everything in their power to be sure that the program operates on the usual time schedule – even if the government is shut down,” Gosliner said.

In the context of the global pandemic, when financial and social inequities and physical and mental health disparities have been laid bare, ensuring access to healthful food is even more important. And with studies showing that hospitalizations increase with longer lags between SNAP distributions, Gosliner said the “absolute last thing” the overburdened health system needs is more people in emergency departments seeking acute care.

“It's the worst time to be having people who need money to feed their families face additional insecurity,” she said. “It's critically important that Congress acts to be sure that there is not any disruption in benefits.”

The authors of the study, “Participants' Experiences of the 2018–2019 Government Shutdown and Subsequent Supplemental Nutrition Assistance Program (SNAP) Benefit Disruption Can Inform Future Policy,” are Wendi Gosliner, Wei-Ting Chen, Cathryn Johnson, Elsa Michelle Esparza, Natalie Price, Ken Hecht and Lorrene Ritchie.

The study can be found online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353319.

Posted on Thursday, September 30, 2021 at 3:24 PM
Focus Area Tags: Family, Food, Health

CalFresh Healthy Living, UCCE educators and promotoras teach children gardening to encourage healthy eating

When local promotoras - volunteer health workers - team with CalFresh Healthy Living, UC Cooperative Extension educators, magic happens in school gardens. Trained by Ceres Partnership for Healthy Families in Stanislaus County, promotoras encourage children to eat well by growing their own produce in school gardens.

In 2018, twenty promotoras  were trained to implement the Powerful People curriculum designed to engage community leaders. This is a partnership with Cultiva La Salud and Ceres Partnership for Healthy Families with funding support from Stanislaus County Health Services Agency. After the training, the promotoras worked with Ceres Unified School District to create school gardens at five Ceres elementary schools where their children attended afterschool programs that host UC Cooperative Extension CalFresh Healthy Living, UC programs.

A key initiative CalFresh, Healthy Living, UC (CFHL) offers in counties throughout the state involves growing fresh produce and making it a regular part of family diets. TWIGS: Youth Gardening and Healthy Eating Curriculum is a UC Agriculture and Natural Resources comprehensive curriculum with 16 garden lessons and 15 nutrition lessons available for free download from its website.

A group of kids water their school garden.

CFHL has teamed with promotoras in Stanislaus County since 2018 to ignite local participation in teaching children that participate in garden clubs about plant and nutrition science, from building soil to creating sumptuous salads. Two years ago, a new UCCE community education specialist was assigned to the project, Rosalinda Ruiz. A native Spanish speaker and a mother herself, Ruiz quickly developed close relationships with the promotoras.

“She's not just their teacher. They look to her as a mentor and a friend,” said Jaci Westbrook, CalFresh Healthy Living, UC Community Education Supervisor for Stanislaus and Merced counties.

Ruiz is also a certified UC Master Gardener, having completed rigorous coursework in sustainable food gardening, pest management, irrigation practices and soil health. She realized the TWIGS curriculum would reach more students if she taught the promotoras how to implement the lessons at school sites.

“This empowered the promotoras to gain knowledge and gave them a different purpose,” Westbrook said. “They don't need to rely on others to offer activities. Working in pairs or small groups, they are reaching 100 to 135 elementary school students themselves.”

Planting day at the Ceres school farm.

Ruiz marvels at the many benefits of food gardening.

“Learning about gardening is the best thing families can do to teach their kids about healthy foods,” Ruiz said. “To grow your own food is a way to get fresh, nutritious food in your home. When kids see the fruit and vegetables growing and they're part of it, they are more willing to try it out.”

During the COVID-19 pandemic, promotoras instruction continued online using Zoom, which was completely new to them, and with WhatsApp, a familiar platform for promotoras to communicate among themselves.

The students are also getting virtual instruction. Promotoras have become proficient at Zoom and are offering simple garden lessons. Socially distanced in-person gardening lessons are also resuming to give children hands-on experience growing their own food.

Posted on Thursday, May 13, 2021 at 8:31 AM
Focus Area Tags: Family, Yard & Garden

Jobseekers get fresh start with JobTrain, CalFresh Healthy Living, UC

Elaine Silver, holding a cabbage from her garden, teaches JobTrain participants how to eat healthy on a limited budget.

Jailene Mendoza is excited to start her new job as a medical assistant in sports medicine in Palo Alto, a job she landed after completing training with JobTrain. 

After her job ended at the Housing Office at California State University, Stanislaus,Mendoza opted for training to help her move into a career that offers self-sufficiency. JobTrain provides career training in fields such as medical assistant, culinary arts, certified nursing assistant, carpentry, building maintenance, IT support and services.

For the past eight years, CalFresh Healthy Living, UC Cooperative Extension has partnered with the Menlo Park-based nonprofit to provide nutrition classes to unemployed residents of San Mateo County.

“These valuable life skills complement the vocational training they receive at JobTrain,” said Elaine Silver, nutrition educator for CalFresh Healthy Living, UCCE in San Mateo and San Francisco counties.

Based on 2018 SNAP-Education figures, 59% of all San Mateo County adults are obese or overweight and an estimated 68,000 county residents are food insecure. To address these health concerns among JobTrain students, CalFresh Healthy Living, UCCE delivers a course called “Plan, Shop, Save and Cook.” 

In these lessons, JobTrain students learn about MyPlate, shopping on a budget, preparing healthy meals and snacks for families, reading food labels, and the importance of physical activity.

Silver encourages reading product labels to choose the most nutritious foods. Shoppers may be able to spend less on a generic brand of a similar product.

“CalFresh Healthy Living, University of California Cooperative Extension courses taught me and provided me with many resources,” said Mendoza, who took the course in the summer of 2020. “I am constantly using the eatfresh.org website for recipes. A handout that has really helped me is the "Eating Better on a Budget." I refer back to this because I have caught myself buying more than what is needed and it ends up going to waste.”

“I also like to watch what I eat because I have the BIGGEST sweet tooth and MyPlate has helped me out with that. I make sure I have my grains, fruits, vegetables and protein before I even consider having any type of sweets.” 

Mendoza said she shared the "Eating Better on a Budget” tips with her family so they can reduce food waste.

In past years, Silver delivered the lessons in person, but switched to Zoom during COVID-19 stay-at-home orders to allow JobTrain students to continue building these important life skills.  

Since October 2020, 128 JobTrain students have taken Silver's virtual Plan, Shop, Save and Cook lessons. The San Mateo County residents improved their skills in planning meals, comparing unit prices, shopping with a list, considering healthy food choices when feeding their families, and using nutrition facts labels, according to a survey conducted after the course.

“I started cooking healthier meals for my family, including veggies,” wrote one survey respondent.

Overall, 88% of the students reported improvements ranging from 43% comparing unit prices more often to 60% using nutrition facts more often. In addition, 28% of participants reported running out of food less often before the end of the month – suggesting they were more food secure after taking the course.

“Some of the changes I've made is that I now look at the unit price, just to make sure I am getting my money's worth,” wrote another student. “Also, I have started taking a grocery list with me so that I can make sure I can stay in budget and not buy things that I do not need.”

Planning meals in advance and making a shopping list help save money and reduce food waste, said Silver.

Asked about the impact these virtual classes have had on students' lives, the feedback from JobTrain instructors has been overwhelmingly positive.

Students look forward to these classes each week, and I love to see how excited they get when they learn about new ways to incorporate healthy practices into their everyday lives,” said Emily Phillips, JobTrain culinary arts instructor, who noted Silver's food safety lessons reinforce training that she teaches people learning food preparation.

Silver also encourages JobTrain students to be physically active and to take advantage of free park passes offered by San Mateo County Public Health through their Park Rx Program. These free park passes incentivize families to spend time in nature to improve their health and well-being.  

“Elaine's workshop has been very beneficial for the students at JobTrain. They utilize her suggestions on nutrition, saving techniques for food and applying healthy living for the student and their families,” said Xavier Gabut, who teaches nursing. “Elaine's workshops are relevant for my students, who will be entering the healthcare field, taking care of and educating patients on health.”

Mendoza, who earned a bachelor's degree in psychology from CSU Stanislaus, has returned to school. While working as a medical assistant in sports medicine, she will be completing her prerequisites for a degree in nursing.  

Posted on Tuesday, March 23, 2021 at 1:07 PM
Focus Area Tags: Health

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