Women, The Family And Health
Bringing Basic Health Care to Underserved and Unserved Populations
Rural areas are often without medical care. The question is “How to deliver basic, non-emergency care to these remote areas efficiently and inexpensively?”
Lack of health care: In the more distant and isolated areas near Fredericksburg, Virginia there was an acute need for basic medical care because there were not enough health care givers to meet the needs of the population. A group of health care providers gathered together and determined that the immediate need was to deliver basic care, screening, and immunizations to children. This group worked with the rural King George County School system to develop a plan to meet the need. This was done in consultation with Mary Washington Hospital in Fredericksburg. Mary Washington serves a primarily rural area with a varying radius of 20–40 miles. After piloting the mobile health program for two years, King George County Schools turned it over to the hospital. Since August, 1999 the hospital has administered the program. The program has been expanded and three more rural jurisdictions have been added to the routes.
Solution: They purchased a mobile unit fitted out with basic medical supplies and staffed by a pediatric nurse practitioner and a nurse. This mobile health unit traveled from one school to another in a 3-county area, spending 4 to 5 hours at each stop. A schedule was devised and published so that parents and children would know when the unit was to be at a particular school. Immunizations were at the top of the list of services, followed by school-entry physicals.
Each unit is a converted mobile home/camper. The communal dining/living area is the reception and consultation area. The bedroom area at the back is converted to an examination room. Between these two areas are banks of supply and file cabinets and a toilet. The kitchen area becomes the work counter. The unit has its own generator, thus eliminating the need for an electrical hookup. Some water is carried on board; the medical staff uses waterless soaps for hand washing.
Expansion to include the adults in the community: In January of this year, in response to community requests, the units now include basic care for adults in need of initial screening, monitoring, and referrals. One of the units concentrates on adult health care and is staffed by a family health nurse practitioner and a nurse. The schedule puts the unit into a community once a month from 9am to 2pm. Evening hours are planned for the future. The unit pulls into a parking lot near a convenience store, next to a church or community center, anywhere a large, mobile home-sized vehicle can park.
Set up: The set-up takes about 5 minutes and includes not much more than taking things out of the cabinets. Everything is stored in covered areas and secured so it does not shift during transport. There is a collection of educational information about such things as asthma, diabetes management, high blood pressure management, and breast self-examination. In addition, they have pamphlets about low cost health care available in the area supported by grants and volunteer medical services.
A typical day: One day, during the 5 hours the unit was in place, there was a steady stream of adults, mostly women, who walked in for a variety of reasons: asthma assistance, sugar and glucose testing, blood pressure checks, how to get an appointment with an ob/gyn, help with dental appointments. The lab facilities enable the staff to do basic blood work and urine analysis. Anything more sophisticated is sent to the hospital’s contract lab.
With each of the individuals, the nurse and nurse practitioner did a wellness screening, consisting of height, weight, waist/hip measurements to determine a body mass index as well as blood pressure, and pulse. Counseling about diet and exercise and the importance of regular health care were included in the chatty conversations they had.
Although there was a steady stream of visitors, it was rare that more than one patient was in the unit at a time. When there were two, one of them was taken to the examination room for private consultation if it was needed. The nature of the visits for the most part were educational and of general interest.
Every person who visited the unit left with information about their concerns and with the urging to see a physician for further help. The medical personnel suggested many cost-free opportunities available in the area due to volunteer time or grants. Everyone left feeling better, more knowledgeable about their particular condition, and (for the moment) determined to do what should be done.
Financial impact: This is an efficient and economical solution for reaching unserved populations. The attractions to this type of service are mobility, reaching more patients with less staffing, and low cost.
- In many areas there is not enough demand for a full-time medical staff.
- The mobile health unit does not carry all of the equipment necessary to fully furnish a physician’s office, thus cutting the cost of outfitting and supplying service to the affected areas.
- Perhaps most significantly, one unit can serve a population that would require the presence of several physicians’ offices.
- With the mobile health unit on the scene once a month the periodic needs of individuals may be addressed.
The public reception of the mobile health units in the communities they serve is testament to the lack of health care provided to isolated and low-income areas. It is also proof that the individuals in these communities will seek health care when it is available to them.
Last Modified: November 29, 2002