A few months ago, a homeless woman stepped onto the mobile health clinic parked near a beach on Cape Cod. As she climbed aboard, the woman was holding her back, in pain.
An NP ushered the woman into an exam room, and the patient began to tell her story. She had tried to seek treatment for her back pain several times before, only to be turned away. The NP ordered some tests and found the woman had a legitimate problem with her back. She was sent to a homeless shelter with a prescription in hand, and the patient finally got relief from years of pain.
“The clinician did a really good job of listening to this patient,” says Elyse DeGroot, MSW, spokesperson for the mobile clinic and its sponsor, the Duffy Health Center in Hyannis, Massachusetts. “She didn’t see this woman as just another emergency room drug-seeking patient. You give people good care when you don’t presume to know what the problem is.”
Growing Need as the Economy Stalls
While many people have an image of Cape Cod as an affluent summer retreat, not everyone who lives there is wealthy. “There are a lot of homeless people here, but they are hidden from view,” DeGroot explains. Since the homeless population is growing due to the bad economy, and the public transportation system on Cape Cod is limited, the Duffy Health Center decided to take a clinic out to where the most needy patients are living. “We have patients who have not seen a doctor in 20 years,” she adds.
As more Americans go without health insurance, the need for mobile health care units is growing, says Darien DeLorenzo, Executive Director of the San Francisco–based Mobile Health Clinics Network. With millions of people visiting emergency departments for what amounts to basic primary care needs, hospitals are shifting their funds to preventive care, DeLorenzo says. Often, that means preventive care on wheels.
Mobile clinics are parking at schools, businesses, supermarkets, and big-box stores across the country. Clinicians on board are offering services that include mammograms and vaccines, as well as dental care, to veterans, homeless persons, and runaways. Mobile health care was especially effective in the aftermath of Hurricane Katrina and the more recent tropical storms, DeLorenzo adds.
Getting NPs and PAs on Board
DeGroot and DeLorenzo say this growing trend is especially well suited to advanced practice nurses and PAs. It takes a certain kind of person to work in a mobile clinic, as DeLorenzo explains.
“You need a person who is self-motivated, who can be very flexible and individualistic, because you’re not going to be sitting there in an office with a lot of staff people around you,” she says. “You’ve got to be confident in yourself—a decision-maker—because if a patient comes in, you’ve got to be able make decisions for yourself.”
NPs and PAs with the ability to practice independently can learn more about opportunities in the mobile health care field during the Mobile Health Clinics Network’s joint conference with the American Telemedicine Association in Las Vegas in April 2009. (For details, visit www.mobilehealthclinicsnetwork.org.) Topics on the agenda include everything from how to conduct a needs assessment and write a grant to how mobile clinics can maintain continuity of care.
Service for All in Need
As a veteran in the mobile health care arena, Larry Friedman, MD, is now seeing the fruits of 10 years of working with troubled youth on the streets of San Diego. Thanks to his mobile unit, which is largely staffed by medical students at the University of California–San Diego Medical School, countless pregnancies and cases of sexually transmitted disease have been prevented.
Ultimately, the clinic has offered a sympathetic ear and helped innumerable homeless teens find their way back into society. “A lot of times, it’s just a place where kids can come and talk about what’s going on in their lives,” he adds.
Friedman says he knew his program had built up trust with the local youth community when two girls from affluent La Jolla stepped onto the van one night. Usually, the mobile unit treats physical and sexual abuse victims, kids with substance abuse problems, and teens who have run away from home. But these girls were extremely well dressed, and they drove up in a nice car. They told Dr. Friedman they wanted an HIV test, but they didn’t want to go to their family doctor because they didn’t want their parents to know about it.
“That’s when I knew there was word on the street about this van,” Friedman says. “We were more than happy to do that for them.”
Setting the Wheels in Motion
Friedman and DeGroot say working onboard a mobile health clinic is one of the most satisfying types of medicine to practice. For those who want to consider a career in this area, or who might want to start up a new mobile clinic, they offer a few words of wisdom.
An important first step is to take the temperature of the community by creating a needs assessment. If another group is already meeting certain needs, then you will know to move in a different direction with your program, they say.
Also, it’s important to identify agencies that might be willing to collaborate. Friedman and DeGroot say their success is largely due to their wonderful community partners. The most successful mobile clinics operate in an environment where everyone knows his or her role and nobody steps on anyone else’s toes.
DeGroot advises new clinics to hire a dedicated program manager who oversees the clinic but does not work on the van. And Friedman says it’s also important to carefully identify your patient population (whom you will treat and whom you will not), so that you can really zero in on helping the people with the greatest needs in the community.
“These kinds of populations require somebody with a great deal of compassion,” DeLorenzo says. “It might be old people, poor people, and a lot of disenfranchised people.”
For health care providers who are looking to get rich quick, mobile clinics are probably not the way to go, she adds. Most mobile clinics get funding from nonprofit organizations and community groups that have a stake in keeping costs down. But if you are the kind of person who is concerned about social justice, fixing our country’s health care crisis, and helping the poor, DeLorenzo says, mobile health care could be a good fit.