by Christopher Richards

When Woman’s Hospital in Baton Rouge, a leader in diagnosis of breast cancer, upgraded their mammography equipment to digital, it became apparent that something needed to be done about their existing outreach program.

The old way

Eleven years ago, when Woman’s started their mammography outreach program, they operated from small vans, wheeling the mammography -units into a remote location. Film processing was done back at the hospital. Now that they’ve upgraded to digital equipment, they abandoned their old analog film processing.

“We had two choices,” said Cynthia Rabalais, director of imaging services at Woman’s Hospital. “We could either abandon our mammography outreach program, or purchase a vehicle that the digital equipment could ride in.”

The only outreach provider in the state

Ms. Rabalais and her administrative team had no intention of abandoning the nearly 5,000 women served by the mobile program. The digital coach was purchased by Woman’s Hospital with the help from several community organizations. Funding from the CDC, through the Louisiana Breast and Cervical Health program serving uninsured and underinsured women, helps to fund mammography services performed on new vehicle.

The mobile mammography unit

“We looked at four vendors before deciding on LifeLine Mobile Inc,” said Ms. Rabalais. “LifeLine was an easy choice, they have a better product, their product is better thought out, and quite frankly, they also build a relationship with their customers. There was never a time that I couldn’t pick up the phone and ask, why are we doing this? Lifeline made us feel very comfortable, and it was an enjoyable learning experience.”

Getting started

It took a year to decide to go digital and select the vehicle vendor. It took a further nine months from the time LifeLine Mobile received the purchase order to delivery date of the mobile mammography unit.

“It seems fitting that LifeLine should take nine months to produce a specialty vehicle for Woman’s Hospital, which offers maternity services,” joked Ms. Rabalais.

Operations

“Going digital is much more efficient. We can see more patients in a shorter time. A big advantage is that there is almost no cost of supplies,” said Ms. Rabalais.

On board the 40-foot long mobile mammography vehicle is a driver-greeter, a registrar who also is responsible for patient intake, and two technologists.

The program reaches the eight-parish service area of Woman’s Hospital and beyond. Staff is specially trained to work with low-literacy patients.

The program hit the streets on November 30, 2006, seeing 26 patients the first day, and is now working to capacity. Woman’s continues to lead the way in effective breast screening programs that are producing real gains in early detection and treatment.

Ms. Rabalais is still suffering from new vehicle syndrome, but she says she will be cured once the vehicle has a few scratches on it.

By Christopher Richards

The Saint Joseph Regional Medical Center (SJRMC) Mishawaka Campus is home to the first mobile healthcare provider to be licensed by the Indiana State Board of Health.

On Aug. 15, the state-of-the-art, 40-foot-long Mobile Medical Unit (MMU) became fully operational. LifeLine Mobile Inc. (www.LifeLineMobile.com), an Ohio-based manufacturer of medical and dental vehicles, built the mobile unit, which houses a medical exam area, a mammography unit with auto-processor, plus an area for intake, information and health education.

After becoming licensed by the state, the process of accreditation for mammography took just over a month. “I wanted to offer this service first to our associates,” said Michelle Peters, SJRMC director of outreach services. “Two people tested positive for breast cancer in the first 100 screenings.”
The paperless office has arrived. Patient information and medical records are all input and kept in a computer database which makes life easier for those on board — and saves valuable space.

On-board is a nurse practitioner, a mammographer, and a driver who is in charge of intake procedures. In addition to the three-person team, a nurse meets the mobile clinic at its destination site to provide free patient education and minor screenings.

However, the clinic does not, in most cases, provide free services. Payment for service is based on individual circumstance. Like its parent organization, the mobile unit follows the same intake procedures as any of Saint Joseph’s fixed-site clinics. Patients fill out (virtual) paperwork, and are later required to submit supporting documentation.

Planning

“We first discussed the idea to deliver mobile medical services six years ago. But then we didn’t have the time to do adequate planning. We were not ready — yet,” said Peters.

Planning began in earnest three years ago with an extensive needs assessment in four local counties. “We found significant lack of access to healthcare. In a number of communities there were no physicians,” said Peters. The study also highlighted the need for medication assistance, and transportation to healthcare facilities.

The first step was to partner with area cancer programs, women’s health services, and other groups with whom the hospital had existing relationships with. “Trust is an issue in the patient population,” said Peters. “Working with organizations that are familiar to the community members makes them more accepting of the new clinic-on-wheels.”

Building on what works

Health fairs have been a great success for Saint Joseph’s community outreach effort. Instead of trying to attract people from other locations to the health fair, the focus is on those in the immediate neighborhood. The MMU is the natural next step in expanding the service to more neighborhoods.
Choosing the vehicle

After research on the Internet and seeing a converted bus model, the outreach team decided upon LifeLine Mobile because the interior was identical to a professional medical facility.

“LifeLine struck a good balance between letting us design the interior space the way we wanted it, and their advice on what would work, what wouldn’t, and why. They sent us some great promotional and educational material. And what’s more, they gave us a list of LifeLine owners to call — and we did call them,” saidPeters.

It was consistent enthusiasm of LifeLine vehicle owners that made the choice obvious for Saint Joseph Regional Medical Center.

“LifeLine is quick to respond, even after the sale,” said Peters. “The mammogram unit wasn’t lined up the way the bio-med people needed it to be. LifeLine stopped everything they were doing and took care of us right away. They took it apart and reconfigured it and got it done in just a day. We were impressed.”

The Future

Future plans are to have residents do rotations on the MMU. It is the organization’s hope that it will eventually be funded by graduate medical education grants from the Family Medicine Center.

Since 2003, the Northwest Community Mobile Dental Clinic has been delivering dental care to those in financial need in the townships of Elk Grove, Palatine, and Wheeling, near Chicago. Ron Buch, executive director of Community Health and Outreach at Northwest Community Hospital in Arlington Heights, Illinois, shares some lessons learned after three years of operating its mobile dental clinic.

Recruiting dentists

Forming a community dental advisory group early has been important to the success of the program. An advisory group is made up of local dentists who provide clinical oversight and help recruit other volunteer dentists. Mr. Buch advises new program planners to start by contacting local dental societies or identifying a high-profile community outreach dentist who is active in business and community groups. The outreach program asks dentists to give a half or full day once every other month, or once every three months.

“We also have found working with a local dental hygiene association very fruitful. Dental hygienists tend to ‘get’ public health better because they are concerned with prevention,” said Mr. Buch. “It’s not uncommon for a dental hygienist to recruit her dentist.”
The outreach program at Northwest Community Hospital is partnered with the University of Illinois School of Dentistry and Harper College Dental Hygiene Program.

Administrative cost savings

To access care to the mobile dental clinic, potential patients must live in a designated township and meet certain financial criteria. . Financial screenings are conducted by each township because most patients are already in the system and receiving local financial assistance.

“Partnering early with the townships helps us to better address both the needs of the township and those of the mobile dental clinic,” said Mr. Buch. “There are real administrative cost savings, and it helps with patient scheduling.”

Digital makes a difference

“Going digital made a big difference,” said Mr. Buch. Dentists are able to rotate images of teeth, and increase the image size for better diagnosis. Patient education is delivered via DVD.

Feedback from dentists is positive. Many of them wish they could have such advanced systems in their own offices. Electronic charts allow for better quality and ease of reporting. Clear and well-organized reports are a must when communicating results to funding sources.

The vehicle was built by LifeLine Mobile Inc., a specialty medical and dental vehicle manufacturer, based in Ohio.

“We spent more money than we first anticipated on our LifeLine vehicle, but it has paid off in spades,” said Mr. Buch. “It’s easy to maintain. We chose LifeLine because of the design of the vehicle and quality of the equipment. All systems were a notch above other things we had seen.”

The Future

This year, the mobile dental clinic is expected to serve 1,800 people. Although an increasing number of children are being served, the clinic is receiving more requests to help the elderly.

“Nursing homes are requesting dental service. We want to respond to that need, but we don’t yet have funds to provide dentures, which is a serious problem, explains Mr. Buch. “Both nursing home management and primary care physicians are telling us that those people don’t have teeth they need to help them eat, so it becomes a nutrition issue. We are hoping to find such funding soon.”

The mobile dental unit is part of a larger medical outreach program operated by Northwest Community Hospital. Future plans are for a fixed dental site to be built into an existing community medical clinic. Patients needing complex and time-intensive procedures will be served at the fixed site, thereby allowing the mobile dental clinic to serve a greater number of patients.

More about Northwest Community Healthcare’s outreach program, and contact information can be found on their website: http://www.nch.org/communityresources/dental.shtml

 Ada Jenkins Center, a non-profit organization in Davidson, NC, took delivery of its new mobile dental clinic last month. Already the vehicle is operating in the North Mecklenburg area, but soon other nearby groups will lease the vehicle.

Six partners are now lined up ready to operate the first mobile regional dental clinics. The first group is expected start using the clinic in August.

“Demand is there. People kept coming to us wanting our service. But we knew that it wasn’t feasible for us to provide care to all of Charlotte and the surrounding area. However, we could provide the facility, and teach other groups to deliver dental care to those in need.” said Ms. Melchor-McCall, the program coordinator.

Ada Jenkins’s previous community dental clinic was leased from the North Carolina Baptist Men’s Association. The new clinic will allow the organization to extend its reach. Twelve hundred patients are expected to be served in the first year of operation, but after five years that number should grow to 5,000.

LifeLine Mobile Inc., (www.lifelinemobile.com) a specialty mobile medical and dental vehicle manufacturer based in Ohio built the clinic.

 “We did some research and LifeLine’s name kept coming up. We were so impressed when we looked at their mobile units. They are so much better than the dark, low-ceiling RV type. When you’re inside a LifeLine vehicle it’s just like being in a dental office,” said Ms. Melchor-McCall.

Two well-equipped operatories, including x-ray, are onboard the 40-foot-long dental clinic, with clean-up space in the center area.

“We have space built out ready to receive a panoramic x-ray machine, and we are now looking to get one donated or find one at low cost,” said Ms. Melchor-McCall. Ada Jenkins already owns a portable hygiene unit so the clinic can operate three operatories simultaneously.

Operating with just one paid driver-manager-dental assistant, the dental clinic is staffed by volunteer dentists.

Funding

Civic groups, churches, and small corporations fund ongoing operations in the primary service area, a four-town region outside of Charlotte. Low-income patients are charged a $10 fee to help offset operating expenses.

In addition to a number of donations from local groups and corporate sponsorships, two major grants from The Sisters of Mercy and The Women’s Impact Fund made the mobile clinic purchase possible. 

While government provides dental assistance to children and the disabled, Medicare does not cover dental care for seniors, low-income adults, or immigrants. Ada Jenkins Center is dedicated to delivering affordable medical and dental care to low-income groups throughout the Lake Norman area of North Carolina.

For information about leasing the mobile dental clinic in Mecklenburg County and surrounding counties, contact:  Julie Melchor-McCall, Coordinator, Community Dental Clinic, Ada Jenkins Center, julie.melchor@adajenkins.org.

Homeless people suffer from medical and dental problems at twice the rate of the national average, according to Anne Nolan, president of Crossroads Rhode Island. The Providence-based organization is the state’s largest agency helping the homeless.

A recent $50,000 donation by Blue Cross & Blue Shield of Rhode Island will cover their operating expenses over the next two years for the agency’s mobile medical van.

The mobile clinic delivers emergency medical services. More than 82 percent of the homeless population is uninsured. Patients would otherwise go untreated or have to rely on emergency room visits — if they could get there. The Crossroads program not only helps the homeless, but also takes some of the pressure off local emergency services.

The work is performed from a 40-foot-long mobile unit built by Ohio-based vehicle manufacturer LifeLine Mobile Inc. “LifeLine has a reputation for building solid vehicles,” said Ms. Nolan. The agency’s previous vehicle was destroyed in an electrical fire.

The mobile clinic has two medical examination rooms, intake and waiting areas, a nurses’ station, blood draw area, storage, and refrigeration. A power wheelchair lift is on board for handicapped access.

Crossroads Rhode Island understands what it takes to operate a successful program. The agency has a long pedigree. It started as a traveler’s aid society 112 years ago. Active participation by board members who advocate for the program is an essential ingredient to success.

“Funding for operating expenses is always a challenge,” said Ms. Nolan. But a volunteer clinical staff helps stretch operating dollars further. The mobile unit has a driver on staff, but the physicians, nurse practitioners, and nurses are all volunteers.

Two factors help recruit volunteer clinical staff for the mobile medical clinic: the agency’s longevity (it is well known in the community), and the tireless efforts of board member Dr. Michael Fine. “Dr. Fine recruits people for us regularly,” said Ms. Nolan. He was named top primary care physician, two year’s running, in Rhode Island Magazine; and is head of family practice for Rhode Island Hospital and Miriam Hospital. Both hospitals are associated with Brown University.

The mobile outreach vehicle will continue to visit soup kitchens, shelters and street locations throughout Providence and the surrounding area four nights a week— thanks to the generous support of Blue Cross & Blue Shield of Rhode Island.

U.S. Congressman Charles Rangel (NY) listened closely as his old friend, Bud Grant, was telling him about a new drug to combat glaucoma and the need to screen people for the disease. Glaucoma is the leading cause of preventable blindness in America.

Congressman Rangel, whose mother had gone blind from the disease, immediately took action. He formed the Congressional Glaucoma Caucus and not long afterward an action committee started work.

At first the Caucus was small. But the idea ignited such enthusiasm that soon membership grew to more than 60. Today, there are over 80 members.

[Congressman José E. Serrano (D-NY) is tested aboard a mobile testing clinic]

Since testing is the only way to know if someone has the condition, the Friends of Congressional Glaucoma Caucus Foundation decided to invest in a mobile unit to travel to areas where glaucoma has usually gone untested. While everyone is at risk, there are higher incidences among ethnic minorities. It is those most at risk who have historically gone untested.

Like any mobile program, sustainability is a key factor to its success, so the Foundation’s outreach effort operates through a network of volunteers.

Brian Quinn, a spokesperson for the Foundation, said, “Volunteering is an attractive proposition for ophthalmologists. They know early detection can prevent blindness caused by glaucoma; and the availability of a mobile testing station lets populations most in need get tested.” When a mobile unit arrives at its destination medical volunteers are ready and waiting.

According to Mr. Quinn, Bud Grant, president of the Foundation, motivates ophthalmologists to volunteer by his personal charisma, integrity, and passion for the program.

The Foundation’s operating expenses are funded by the CDC with a few small grants from corporations. The CDC Minority Health program funded the purchase of the first mobile clinic from Ohio-based manufacturer, LifeLine Mobile.

The program proved so successful that the Foundation was able to secure more CDC funding for two more mobile testing stations from LifeLine. “We now have four vehicles from LifeLine: one in San Francisco, one in Washington D.C., and two based here in New York,” said Mr. Quinn. There are many requests for screenings so the vehicles are constantly on the road.

Student Sight Savers is another successful program supported by the Friends of the Congressional Glaucoma Foundation. Medical students conduct hundreds of screening aboard mobile outreach vehicles. More than 40 medical schools are now involved in the program. Students provide a valuable service to the community while gaining clinical experience.

“It’s a win-win situation,” said Mr. Quinn.

April 10 sees the rollout of a new medical and mental health program to serve approximately 1,200 students at West Frankfort and Benton high schools. Services will be delivered by Care-A-Van, a 40-foot-long mobile medical clinic, just arrived at the Southern Illinois University (SIU).

The mobile school health clinic is the brainchild of Dr. Penny Tippy, professor of family and community medicine and director of the Family Medicine Residency Program at Southern Illinois School of Medicine, in Carbondale, Illinois.

“Second- and third-year residents are required to get out of the traditional role of the doctor and learn how to work within the community,” said project coordinator Robynn Nawrot. Resident family physicians will be on board Care-A-Van.

Dr. Tippy and her all-woman team of three health professionals can now add “truck driver” to their résumés. Each holds a commercial vehicle license as required by the state.

“From the beginning, Dr. Tippy always wanted the rural health clinic to be a mobile unit,” said Ms. Nawrot. “It’s been three years to the month since we started planning.”

At first, there was no money. Dr. Tippy sought input from business, community, and local government leaders. The top need was soon identified: mental health care, followed by medical and dental services.

Funding for the vehicle purchase was not straightforward. Some funds for planning came from the Office of the Lieutenant Governor, Patrick Quinn. A year-and-a-half after “almost” succeeding with one organization, grants became available through Illinois Children’s Healthcare Foundation (ILCHF).

ILCHF is a new state-wide funding agency in Illinois, and the only one with a focus on children’s health. “There are severely underserved populations in rural parts of the state, primarily down state. So, we were trying to pay special attention to those applicants,” said Susan B. Kerr, president of ILCHF.

ILCHF wanted to send a message that they are statewide, and willing to look at a variety of programs. “We were going over 300 requests for proposals during our first grant cycle, but the mobile program application jumped out at me. I’ve been an enthusiastic supporter of mobile health for a long time,” said Ms. Kerr.

Illinois Department of Human Services, School Health Division awarded an annual grant to assist with the cost of operations. “It’s not a free clinic. Those with either state or private insurance will be billed, but no one will be turned away if they have no insurance,” said Ms. Nawrot. “The SIU School of Medicine is committed to the success of the Care-A-Van.”

Ohio-based specialty vehicle manufacturer LifeLine Mobile Inc. built the Care-A-Van. On board are a laboratory, and two exam rooms. One will be used for counseling or medical examinations. The mobile unit has its own wireless internet connection. The students at both high schools created the exterior artwork—one design on each side.

“LifeLine came highly recommended. They willingly invested a lot of time with us before we even had funding. But we knew we were going to get it [funding],” said Ms. Nawrot. “Lifeline was extremely patient, and they were able to make changes as we changed our minds. They made good suggestions. Sometimes we could afford their suggestions and sometimes we couldn’t. We had to work within our budget.”

It took three years to get SIU School of Medicine’s program on the road, but now Dr. Tippy’s dream has become reality. Persistence plus passion pays.

The Good Samaritan Medical Clinic is proud to announce their brand new 40-foot mobile medical clinic! The mobile unit takes to the streets this month and will bring care to Wichita’s urban poor.

The program is the inspiration of World Impact, a faith-based organization that has been providing medical care and spiritual solace to the urban poor since 1987.

World Impact chose Wichita, Kansas for the location of their first mobile medical vehicle after thorough research. The emergency room is the only available care for many of Wichita’s urban poor. And many have no way of getting there. It’s common for patients in this population to have no record of their medical history.

Doctors on board will be able to take medical histories, write prescriptions, and dispense medicines.

Previously, the outreach program has been operating from three churches. The mobile medical clinic will service seven more locations. World Impact’s program benefits the whole community. Not only does it help the patients, but also it takes some of the pressure off the emergency room in local hospitals.

“We spent a lot of time researching the need and whether or not we would get local hospital support and government grants” said Nick Martineau, the outreach program director. “We’ve been given the gift of an expensive medical van and we want to use it to its fullest potential.”

Lynn and Foster Friess Family Foundation donated the vehicle. The new clinic has two medical exam rooms, a medical laboratory, refrigerator, restroom, office area, waiting room, and storage space for medical equipment.

World Impact looked at many options before purchasing the specialty medical vehicle. After flying to visit two mobile medical manufacturers, they finally choose Ohio-based LifeLine Mobile Inc.

Nick Martineau said, “LifeLine was the clear choice because of their service and support. When they delivered the van, they spent a day going over how everything works. At this beginning stage, we call their helpline every day for advice. ”

A team of volunteer medical staff will staff the clinic. Operations are funded by numerous government grants and individual contributions. Some of the staff are active fundraisers and provide additional support.

World Impact and Good Samaritan Medical Ministries hope to duplicate this ministry in a number of cities.

When Michael Johnson eases back in his chair to think about the one main ingredient to their successful mobile programs, he calmly states, “You can’t live off a good idea. Before starting a mobile dental service, you have to know how you are going to sustain it,”

Mr. Johnson, director of mission outreach and community benefit for Saint Mary’s Health Network in Reno, emphasizes the importance of planning an ongoing mobile outreach program. “Planning for sustainability is the key to the success of Saint Mary’s mobile dental program.”

Saint Mary’s Health Network in Reno is in its fourth year of delivering outreach dental services to low-income residents of the northwestern part of the state. The program started because few Nevada dentists take uninsured patients. The hospital operates two mobile dental programs: preventive and restorative. Both programs are aimed primarily at children on State Children’s Health Insurance Program (SCHIP) and Medicaid, with twenty percent of patients as private pay adults.

“Take Care-A-Van” is a 40-foot long mobile dental unit that concentrates on providing sealants and preventive education. The outreach van visits designated schools within a 90-mile radius of Reno. The State of Nevada helped fund the program with an oral health initiative grant.

A 53 foot mobile outreach unit delivers the general dentistry restorative program.

Ohio-based specialty vehicle manufacturer, LifeLine Mobile Inc., built both units. “We chose LifeLine because we’ve had such good experience with them. Saint Mary’s operates four LifeLine mobile units,” said Mr. Johnson.

According to Mr. Johnson, Saint Mary’s takes a comprehensive approach with three levels of care: prevention, restoration, and major dental surgery. Children needing more than prevention are referred to the mobile restorative program. For occasional major dental surgery, Saint Mary’s operates a fixed site where general anesthetic can be used instead of subjecting a child to a series of taxing procedures.

“While many programs start because of a generous donation or a need, this is not enough to keep them going,” said Mr. Johnson. On the subject of funding, he adds, “It’s a mistake to put all your eggs in one basket. All funding sources change. Grants and donations come and they go.”

Sustainability preparation is a constant activity.