Traveling Care

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Trusted Leader - February 2007   

By Erin Prather Stafford

Traveling 60,000 miles along the Texas border, a mobile health clinic operated by The University of Texas Health Science Center at Houston has provided health care services for more than 30,000 patients since its inception in 1989.

L. Maximilian Buja, MD, the health science center's executive vice president for academic affairs, says a new van, unveiled last March, is the third vehicle model to provide health care services and education to large, rural indigent populations along the border.

"Dr. Margaret McNeese, medical director of the mobile health clinic program, originally came up with the idea of using an old hearing/speech clinic that was no longer being used," Dr. Buja explained.

"She suggested the van be refurbished for primary health care and used along the border. State officials allocated funds for border health, which were applied to the program. Since then, we've relied on both state dollars and grant money. It took this public/private partnership to purchase the current version."

Colorful and high-tech, the van is painted UT burnt orange with "Clinica de Salud Movil" on one side and "Mobile Health Clinic" on the other. It's equipped with three examining rooms, an education room with medical and nutritional information, and the latest laboratory equipment and technology, including telemedicine capability. In 2005, the clinic provided primary health care and education to more than 3,000 patients and immunized more than 2,000 children.

Kathleen Becan-McBride, EdD, coordinator of UT-Houston's Texas-Mexico Border Health Service Project, says the van serves border residents living in areas that typically don't have electricity, running water, paved roads, or medical care.

"Often, mothers will walk with their children to the mobile clinic for treatment. We try to ensure the van is in an area within walking distance of the population needing to be served. Because the border is an expanded community within UT-Houston's outreach, we believe it's mandatory that health care access exists for these communities," she said.

Dr. Buja says the van has been a fantastic teaching site for both medical students and nurses interested in primary care. 

Houston, We're Connected  

Today, UT-Houston physicians are continuously in contact with staff aboard the mobile health clinic, as well as nurses at rural school-based clinics. Telemedicine allows physicians to communicate with border patients, even when hundreds of miles apart.

"A nurse can evaluate a patient, then call a UT physician in  Houston for an examination. With the nurse using the telemedicine equipment, either at the school-based clinic or on the mobile health clinic, the physician can also see the examination and give a diagnosis and recommendation. If medications are needed, they are called in to a local pharmacy. Should additional treatment be needed, a referral will be made to the closest doctor in the patient's community," Dr. Becan-McBride said.  

The first school-based telemedicine clinic was established in 2005 through funding from the Cullen Foundation. There are now two school-based clinics in Cameron County and two in Hidalgo County where UT-Houston has provided telemedicine equipment. Each county is designated as a medically underserved area and a health professional shortage area.

The most common complaints seen by clinic staff are headaches, stomachaches, coughing, ear and throat pain, and psychiatric issues. Patients are required to sign a consent form saying the nurse has their permission to use a telemedicine consultation for their treatment.

UT physicians also provide interactive educational programs to elementary schools on topics including hygiene, avoiding skin cancer, and diet to avoid diabetes. Educational videos about diabetes prevention have been used in the van for 13 years and are being updated for the mobile and other clinics to use for health education and disease prevention.

"Clinic staff can do glucose and cholesterol screenings," Dr. Becan-McBride said. "An important goal of the program is to prevent diabetes and other diseases by identifying and educating those prone to the disease."

Added Dr. Buja, "Health and education are keys to a successful and vibrant society. Prevention is essential, and diabetes is a prime example of what can happen if things remain unchecked."

While there have occasionally been technological glitches, Dr. Buja says the program's benefits far outweigh any headaches caused by a downed server. For him, the mobile health clinic, its school counterparts, and telemedicine are essential parts to improving border health care.

"I personally feel as a physician I need to deliver care to all people in all levels of society.   Texas physicians need to look beyond the big city to the rural areas of our state. Patients there are counting on us too."



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