Columbus Monthly / December 2011 / Medical care on the move

 Email  Print

Medical care on the move

Healthcare professionals are using everything from customized coaches to community health fairs to deliver care to those in need.

Nearly every day of the week, there are vans and semis circling the city providing mobile healthcare to the residents of Central Ohio.

Sometimes the care is free, provided through hospitals’ charitable programs to people who can’t afford medical treatment. Other times, corporations request a visit—arranging for a local hospital to bring its mobile mammography unit to a company’s parking lot, for example, so employees have no excuse for not getting exams that can detect breast cancer. These doctors’ offices on wheels are staffed by medical professionals who provide care, offer advice and give direction on follow-up care.

Medicine also hits the road at health fairs, often held in communities where residents may be uninsured or have transportation issues that limit their ability to schedule screenings or wellness care.

This summer, 74 student athletes received free sports physicals at the Ohio State University Medical Center’s annual Community Day health fair. There have been years when that free physical may even have saved a young person’s life, says Elizabeth O’Connor Seely, executive director of University Hospital East. A pulmonologist who volunteers at the annual event listens carefully to the young athletes’ lungs. “She’s identified some kids who need ongoing care and she hooked them up with her office,” Seely says.

Sometimes people show up for a screening and actually wind up in the hospital, she adds. “From year to year, there have been people who we have identified as an emergent situation and we’ve gotten them into our emergency room.” Conditions such as hypertension or high blood sugar levels can land someone in the ER for treatment before they even realize they have a problem.

Such detection is the goal of the health fair.

“Community Day is an annual event that we’ve had for 11 years,” Seely says. It’s usually scheduled for the third Saturday in June and is targeted to Central Ohio residents who otherwise might not be able to afford essential health screenings and physicals. “This year, we held it at our new outpatient care center at Leonard Avenue and 670.”

The day-long event provides a multitude of free screenings to check cholesterol, blood sugar, pulmonary function, body mass index, hearing and vision. People attending Community Day also have access to the OSU mobile dental van, breast and prostate screenings, fall and risk assessments and sports physicals.

The 2011 event attracted 217 people who checked in for health screenings, including the student athletes who got physicals. Several hundred other people showed up as well, just to get information, Seely says. “It’s really pretty comprehensive,” she says. “We give the opportunity for any community agency to have an exhibit there. To make it fun, we have live music, the Saints Drumline, clowns, professional face painters. And we have roasted corn on the grill and turkey dogs and water.”

The OSU Medical Center is not alone in its efforts to take important healthcare screenings to the public. Increasingly, physicians’ practices and hospitals are investing money in mobile healthcare units in an effort to help people detect diseases such as prostate and breast cancers—and even to provide essential prenatal care for young expectant mothers.

In 1993, after extensive research by a nurse at OhioHealth, the hospital system rolled out Wellness on Wheels as part of its Project to Reduce Infant Mortality. The aim of the project is to provide free prenatal care to teen mothers in lower socioeconomic areas. “It’s actually a semi truck that has been converted into a mobile health unit,” says Sonia Booker, the nurse manager for OhioHealth’s community outreach/Wellness on Wheels. “It has nine rooms.”

When the 18-wheeler hit the streets, she says, it was the first mobile unit in the state. “In 1993, it started at East High School and South High School,” Booker says. “Those schools sit in the highest area of infant mortality in our city.”

The OB/GYN office on wheels helped Columbus Public Schools accomplish its goal of having the pregnant students graduate from high school, while also helping the hospital system meet its pledge to reduce infant mortality.

“By taking the care to the schools, it helps the girls not miss school,” Booker says of the program, which has seen patients as young as 12 and as old as 48. (Expectant mothers who are not in high school but need free prenatal care can get a referral to the program, Booker says.) The mobile unit has a dedicated medical team of four board-certified OB/GYNs who rotate shifts on the unit, along with a registered nurse, a social worker, a registration person and a driver. Over the years, Booker says, the numbers have proven the program is working. “We have had over 3,500 patients,” she says. “We have delivered more than 2,000 babies.”

Booker can recall many success stories due to the mobile unit, which now is on the road five days a week and rotates among four Columbus high schools: Brookhaven, Walnut Ridge, South and East. The patients have regular appointments with the doctor on the mobile unit: When a student’s appointment time comes, she gets a pass from her school nurse, then reports back after the appointment is over, Booker says. The entire process usually doesn’t take longer than an hour, so the missed class time is minimized, she adds.

“Just recently, we had a girl who was a sophomore in high school whose grandmother was raising her,” Booker says. “The young girl was timid and had a lack of knowledge of what was going on with her body.” Through the prenatal care she received and the education the medical team provided her, the girl was able to give birth to a healthy baby at Grant Medical Center, where most of the births take place, Booker says.

“I really am proud of her because she was able to get through the delivery process and the baby was born healthy,” Booker says. “We individualized the care plan for her. We gave her a lot of education about how to take care of the baby, about the birthing process, because she was a small girl, and we told her what to expect when she reached the hospital.”

The Wellness on Wheels program has been around long enough to start serving a second generation of teenagers. The very first pregnant teen who was treated through the program came back to speak about its benefits when the hospital dedicated a new semi three years ago, Booker says. The healthy baby who was born from that pregnancy also received care through the mobile unit—but for a different purpose.

“The baby who grew up to be 15 then came back and got her sports physical on the mobile unit,” Booker says. She explains that the unit provides free sports physicals to students in the Columbus district in September, February and May.

“We’ve serviced more than 5,000 middle school and high school students” since the unit started providing physicals in 1998, Booker says. “And 300 of those students, we had to refer out for further care for unidentified illnesses.” Doctors have detected heart murmurs, elevated blood pressure, asthma and other illnesses in teens. In those cases, she says, the students are not released for sports activities, but are referred back to school nurses and their parents are notified. The program works with the district to help the children find affordable healthcare through OhioHealth or Nationwide Children’s Hospital, either at a free clinic or one that charges a sliding fee based on income levels.

Hospitals make significant investments in their mobile outreach programs, whether it’s through a unit on wheels or a health fair. Mount Carmel Foundation, for example, devotes nearly $1 million a year to mobile outreach, which includes street medicine (providing free medical care to homeless individuals who are “living on the land,” rather than in shelters) and the hospital’s Mobile Outreach Medical Coach, which travels throughout Central Ohio to soup kitchens, homeless shelters, food pantries, churches and other locations as identified by need. The clinicians on the mobile unit are able to treat acute and chronic illnesses, provide preventive healthcare education, do health assessments, perform physicals and refer patients to primary care doctors and social services, says Mount Carmel spokeswoman Janice Piscitelli.

“It is designed to be an urgent care center on wheels, from a clinical perspective,” says Brian Pierson, director of community outreach for Mount Carmel Health Systems. The unit, a custom coach that has been transformed into a medical unit, has two exam rooms, a pharmacy and an X-ray area. As with the Wellness on Wheels program at OhioHealth, this mobile unit has a dedicated medical team.

“Typically, we’ll have two or three RNs, one physician, one nurse practitioner, one bilingual translator, a data entry clerk and the driver, who also is an EMT and a pharmacy tech. All of those services are provided at no charge,” Pierson says.

The mobile unit goes out five days a week to see patients and often is booked on the weekends for community events such as health fairs, Pierson says. Over the years, the mobile unit has counted 75,000 patient encounters, and he says the number of patients who receive treatment on the unit increases each year.

“We experienced 1,167 patient encounters in 1998, the first year of the mobile coach,” he says. “We are on track to exceed 4,000 patient encounters this fiscal year on the coach, with additional encounters outside the coach in different service events, like health fairs.”

The mobile outreach has many success stories, Pierson says, recalling the care the street medicine team gave to a homeless man in his early 50s. The man recently had been treated for bladder cancer, and as a result had many other medical conditions, Pierson says. The team found him sleeping on a bench and saw clinical signs of medical problems, including an infection. They were able to get him treatment and offer other assistance. “Within four weeks, they had gotten him proper medical supplies and they got him off the street and into an apartment,” he says.

While mobile units often go to areas of the city where people might not have regular access to healthcare and are uninsured or underinsured, many of them also have contracts with area companies that request the units for certain exams. Mobile mammography units, for example, are a common sight in many corporate parking lots these days.

“We do go to certain corporations on a quarterly basis, depending on the number and age of the women working there,” says Kay Holland, regional manager of OhioHealth’s mobile mammography unit, which is on the road every weekday and approximately three out of four Saturdays for various community events. Ohio State’s Arthur G. James Cancer Hospital has a mobile mammography unit that operates on a similar basis.

A mammography is one of those tests women tend to put off, but having the van sitting in the parking lot leaves little room for excuses, especially when the exam takes only about 30 minutes, Holland says. “It’s really a great opportunity,” she says. “A lot of the corporations today are really pushing wellness, and women tend to put themselves last.”

Follow-up care with all mobile healthcare units is crucial, officials say. Without it, the initial diagnosis—detecting a heart murmur in a teenage athlete, for example—doesn’t help much.

Part of Ohio State’s follow-up for its Community Day screenings begins on the day itself, with some volunteers who are financial counselors at the OSU Medical Center.

“All of the specific screening areas have resources and handouts for where they can get additional care,” Seely says, noting that Ohio State has an open access policy, so anyone can seek medical care through its hospital system. But the financial counselors also talk to patients about where they live and what services are available in their neighborhoods. “They go through the resources that are available,” Seely says. “We really do hook people up with where they can get ongoing care.”

The primary goal of Mount Carmel’s outreach program is providing immediate medical care through its mobile coach or street medicine program. “But we strive for everyone to leave with a referral to a primary care physician or a free clinic or a clinic with a sliding-scale fee,” Pierson says. “Our third goal is to meet the needs of the whole person—biological, psychological, social and spiritual. Our nurses and care providers will try to follow up as best as possible. Sometimes follow-up is difficult. But we have a homeless advocate who is on the land every day.”

 

Operation walk

Nearly 50 surgeons in more than a dozen states across the country will be working together Dec. 2 and 3 to get the uninsured working poor back on their feet through Operation Walk USA.

The idea for the nationwide effort began locally, after two Central Ohio orthopedic surgeons worked with Mount Carmel earlier this year to launch Operation Joint Implant, a program that allows uninsured patients to receive free hip and knee joint replacement surgeries.

The surgeons, Adolph Lombardi Jr. and Keith Berend of Joint Implant Surgeons Inc., have traveled abroad to donate their services to patients in Nicaragua, Guatemala and Cuba. The two had the idea to offer a similar program in their own community and asked for Mount Carmel’s help in funding it. “They agreed that this was a good idea,” says Lombardi. The first free surgery was done in January. “Over the past year, we’ve done about a dozen patients,” he says.

 A recent beneficiary of the free implants is Eric Ahlteen, who owned Espresso Yourself Music Café in Powell. Though his business recently closed, Ahlteen made many connections there over the years, including a friend who told him about the Operation Joint Implant program.

“Ten years ago, I fell from a tree and broke my right hip, and it’s just been degenerating more and more,” says Ahlteen. “The last two years, it’s been getting worse and worse, and I even developed a limp.” He had been self-employed for years, pouring every penny he earned back into his business. Health insurance was a luxury he couldn’t afford. “I haven’t had insurance for six years,” says Ahlteen, who fit the financial criteria for the program.

Candidates for the program can’t be eligible for third-party payor assistance such as Medicaid, and they must be at or below 200 percent of the poverty level, says Janice Piscitelli, hospital spokeswoman. Mount Carmel learns about some of the candidates for free surgery through its mobile outreach program; other referrals come through the hospital’s orthopedic clinic and family practices.

When Lombardi became president of the Hip Society in February, he proposed a national day of joint replacement surgeries. It didn’t take much cajoling to get physicians to volunteer for the December event. “We have 48 doctors signed up to do this all across the country,” says Lombardi.  “They thought it was a great idea to bring it home and do it in their local environment.”

Lombardi has been working with the physicians to get vendors to donate necessities, such as pharmaceuticals and the actual artificial joints. The joint-replacement surgeries can be life-changing for someone who is facing a lifetime of disability because it enables them to get back on their feet, Lombardi says. “We operated on a father of four who couldn’t work. We did his surgery so he could become employed.”

Ahlteen says he couldn’t have afforded everything he has received, from the initial X-rays and preoperative tests to a two-day stay at the New Albany Surgery Center, plus anesthesia and medications. About a month after the surgery, which Lombardi performed, Ahlteen was back on his feet, working on the physical therapy exercises he was instructed to do and looking ahead to better times. “I’ve kind of graduated from the walker to the cane,” he says. “I’m trying to keep a positive attitude.”

 “Without this program, I’d definitely be in pain. I probably would have had to file for disability,” Ahlteen adds. “I could never have done this without their help.

Michele Lemmon is a freelance writer.