Kentucky's "backside workers" care for million-dollar horses on the racing circuit. This clinic takes care of them.

Seventeen years ago, Odilia Castillo, now 37, traveled from her home in Chiapas, Mexico, north to work as a "hot walker" on Kentucky's race tracks. Every morning she wakes up at 3 a.m. and heads to the track by 4 a.m. to walk the horses, who need at least 30 to 45 minutes to cool down after training. 

Castillo said she has a "connection with the horses," and that's what kept her caring for the animals — until, in 2021, she couldn't work because of a pain in her stomach. She said she didn't know what the pain was, so she went to the Kentucky Racing Health Services Center. The Louisville clinic was founded in 2005 to meet the needs of those known in the racing world as the "backside," mostly migrant workers who care for the horses who race at tracks such as Churchill Downs.

The mother of two, who is married to another racetrack worker, needed to take days off from work — a dire challenge for these laborers — many of them migrants from Mexico, Guatemala, Venezuela or other Latin American countries — who head to the tracks six days a week to help keep Kentucky's estimated $2.7 billion annual racing economy galloping. They are the hot walkers, exercise riders, grooms and farriers necessary to maintain racing form for the 238,027 horses in the state.

Many backside workers are undocumented — and don't have job protections — but are essential to care for the million-dollar horses running Saturday in the 2024 Kentucky Derby, known for its fashionable hats, mint juleps and billionaire owners.

That's where the clinic steps in. 

"A transient workforce that needs to stay healthy"

Some backside workers are hired by the trainers through the H-2B temporary worker visa program, but many are undocumented because the demand for people to care for and feed the horses far outpaces the visas issued. 

An average stable hires one person for every two horses, trainer William Jordan Blair told CBS News and backside workers are an "integral part of every single operation." Backside workers care for about five to six horses during their day. He said it was a challenge to find steady workers for his 30-horse stable, Jordan Blair Racing, and for many others in the racing circuit, partly due to the transient nature of the business.  

"It's a transient job, not by choice, but that's the way the business is — not easy to find workers," Jordan said. 

Workers, who usually are hired by the trainers and stables, typically move with the horses three to four times a year to different racing tracks in Florida, Kentucky, New York and other states, and each track is different. Many provide dormitory housing — in various conditions, said Jordan – and some of the bigger ones provide childcare and sometimes healthcare. 

"It's easier to keep help when the workers are younger," said Jordan, who said when workers are younger, they don't mind moving as much. "But when they have families, it's difficult to uproot." He said losing experienced workers made it challenging for the horses and the stables. Workers are paid on average in Kentucky $13 an hour, he said, but can make more — or sometimes less — in other states. 

But for many workers, it is a crapshoot, said nurse practitioner Krista Roach, who started working at the clinic in 2019.  

"It's rough when they leave for a few months," Roach said. "It's like starting from scratch all over again when they return." 

She said she's seen workers not get medication or help for various ailments including diseases such as diabetes, and occasionally STIs. 

A common refrain from workers is the fear of missing work for even a day. Worry pervades the backside that if they miss work, other migrants will come to replace them — or they will be fired.

"If you want a job the next day, you won't take a day off. Unless you have an understanding boss, you are here every day," one worker told a researcher in a study on how these workers treat their health. 

Unclaimed racing tickets fund a clinic

These are the challenges the clinic tries to address for the backside workers who seek help. Most workers come via word of mouth, as "word travels fast on the backside," an often close-knit community, said Roach.

Unclaimed racing tickets collected by the state of Kentucky support the clinic to the tune of $700,000 annually — and dedicated nurses, bilingual doctors, physician assistants and administrators ensure workers get the services they need. 

Nurse Dedra Hayden, director of the center and an associate professor at the University of Louisville's nursing school, which hosts the clinic, has a policy when it comes to caring for the mostly Latino workers on the state's racing circuit. 

"I just don't ask," Hayden said, referring to patients' immigration status. 

"We try to provide them a safe environment," Roach said. She recalled seeing one worker who asked nurses to cut his toenails. He didn't wear shoes on the tracks and his feet were in such bad shape that he was fearful to touch them. Nurses cut his toenails and bandaged his feet so he could return to work. "He was so grateful," Roach said. Since Roach joined the clinic in 2019, she has worked to expand health care for female backside workers who tend to use the clinic for services. 

They've seen 1,010 female patients and expanded their services to include OB-GYN examinations for women, cancer check-ups and help for families and children. Castillo said she had gone to so many doctors to find out what was wrong. 

"For those years I had fear because I didn't know what was wrong with me," Castillo said — until she got to the clinic. 

She had surgery, and after a month-and-a-half, was able to return to work to care for the horses that she "feels in her soul."

In:
• Horse Racing
• Kentucky Derby
• Kentucky

Cara Tabachnick

Cara Tabachnick is a news editor and journalist at CBSNews.com. Cara began her career on the crime beat at Newsday. She has written for Marie Claire, The Washington Post and The Wall Street Journal. She reports on justice and human rights issues. Contact her at cara.tabachnick@cbsinteractive.com