La Linea Fronteriza
SPECIAL FEATURE
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Traveling Medicine
Mobile clinic, telemedicine brings health care to the Valley
By Darla Brown
It's 7 a.m. and the summer sun is already searing the palm trees and orange groves that line highways of the Lower Rio Grande Valley. Elma Requenez, R.N., climbs in behind the wheel of a 30-foot RV, and starts it up.
Requenez isn't a Texas Snowbird out for a daytrip to enjoy the scenery of a birding sanctuary or to collect shells on South Padre - she's heading out to work, steering the UT Medical School's mobile health clinic into the impoverished, unincorporated neighborhoods along the Texas-Mexico border known as colonias.
Across dirt roads and past modest dwellings, some without indoor plumbing, Requenez, the mobile clinic's nursing care coordinator, and her staff bring free care to anyone who comes to the rolling clinic's door.
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The mobile clinic has been providing free health care in Hidalgo County for 15 years as a result of a special line-item approved by the state Legislature.
"Back in 1988, the Legislature realized the deplorable condition of health care along the border and asked for schools to develop projects to help out," explains Kathleen Becan-McBride, Ed.D., coordinator of the UT Health Science Center's Texas-Mexico Border Health Service Project.
"Dr. Margaret McNeese, the medical director of the program, remembered that Houston Speech and Hearing had an unused van and suggested we resurrect it to provide health care," Dr. Becan-McBride adds.
For years, the make-shift mobile clinic rolled through the Valley, and then eight years ago, a specially designed mobile clinic was created for the program.
The mobile clinic is sectioned into three areas: the front driving area is also a place where patients can be counseled; the center section is where a patient's blood pressure, height, and weight are checked; and the back section is set up just like a tiny examining room, complete with a reclining patient bed, a sink, and physician instruments.
"We can see three patients at once with this set up," Requenez explains.
There are special considerations because of the mobile nature of the clinic: reference guides must be strapped down with bungee cords, and Velcro is used to secure blood pressure cuffs to the window sills. Space is at a premium: file cabinets are fitted perfectly under the countertops and seating is singular -- no couches, or a dining table like a regular recreational vehicle - although there are two mini refrigerators: one for the employees' lunch; the other for medication.
"Many patients in the Valley are not mobile - they don't have access to transportation, or to health care, so it makes sense for us to take the clinic to them," Dr. McNeese explains.
The clinic, staffed by Requenez, Emma Vera, and Virginia Cortina, makes its stops at four elementary schools located in the colonias - stopping at each one for a two-month stretch. The word is spread before the van's arrival via fliers in Spanish and English.
"We chose the school locations because they are in colonias near several concentric circles of other colonias so that we can hit the broadest population possible," Dr. Becan-McBride says. There are more than 1,000 colonias in Hidalgo County alone.
At first, the clinic only saw pediatric patients, but now adults also are seen. Three-thousand to 4,000 patients a year come to the clinic, presenting with a full range of health-care problems.
"Diabetes is the biggest problem that we see here," says Emma Vera, L.V.N. "We have had to refer some patients to the emergency room when their blood pressure or their blood sugar is too high."
"Most people don't have doctors here, or insurance," she adds.
As a result, programs such as the mobile clinic are helping to alleviate the burden placed on the area's hospital emergency rooms, which are required to treat patients.
"By seeing patients out in the community, we're taking the care to them and managing the issues earlier, but our nurses have had to deal with emergency situations," Dr. Becan-McBride says.
The clinic travels to schools only on the U.S. side because it is state owned and operated program - even though the patients may or may not be U.S. citizens.
"Because of liability issues, we cannot go across the border," Dr. Becan-McBride says.
But the clinic does offer medical care instantaneously -- from more than 300 miles away.
The Houston connection
In Houston's Texas Medical Center it's an equally hot day as the sun reflects off the mirrored skyscrapers and silver light-rail train that whispers down Fannin. On the 10th floor of the Hermann Professional Building, a patient is being seen.
Via teleconferencing equipment, the patient describes her symptoms to Dr. McNeese in Houston as she sits in the mobile clinic's examining room more than 300 miles away.
Thanks to a $250,000 grant from the Cullen Trust for Healthcare, the mobile clinic's services have been expanded to include the latest telemedicine technology.
"Our first foray into telemedicine involved hauling a 10-foot satellite dish on the back of the mobile clinic. Elma had to hook it up, and it was quite cumbersome," Dr. Becan-McBride recalls.
"Before the Cullen Foundation's generous gift, we were operating telemedicine on a shoestring budget," Dr. McNeese adds. Damage from Tropical Storm Allison put the clinic's telemedicine capabilities out of commission for more than two years.
Today, a T1 line (referred to as the "umbilical cord") allows for the transmission of real-time information in video and sound via a laptop computer. Patient information is first transmitted to the Medical School's student clinic office and then the physician treats the mobile clinic patient through the help of Requenez, a computer monitor, and a video camera.
"We even have peripheral devices that help the doctors. For instance, I can put an instrument in the patient's ear, and the doctor sees it on her screen magnified," Requenez says.
There is a derm scan to view suspicious topical problems, such as moles, and a scope that broadcasts magnified pictures of the patient's throat also is used.
"The physician can do a complete physical with the exception of palpating the patient (hands-on examination), and for that portion of the exam we rely on the nurse and medical student," says Kelly Bolton, R.N., who works with the program on the Houston side.
Patients are referred to the Houston medical team for psychiatric problems as well. "These are usually pediatric patients who are triaged through the schools," Dr. McNeese says.
There are cases when patients are referred to physicians in the Valley community, or directly to the emergency room. But, telemedicine has found its place in the Valley.
"Telemedicine helps to cut down on the rate of absenteeism at the schools and the follow-up rate is much better since the mobile clinic comes back day after day to the same site," Dr. McNeese says. "This clinic allows a whole new population to have access to physicians in the Texas Medical Center."
Nurses on the mobile clinic translate for the patients to the physicians, if necessary. "Many of our doctors speak Spanish, and many are board certified in Internal Medicine and Pediatrics so that they may treat both children and adults," Dr. McNeese adds.
Educational opportunity
The mobile clinic is an educational stop for students from many health disciplines across the state.
In addition to fourth-year Medical School students who come to the mobile clinic for a one-month elective in family medicine, third-year medical students from The University of Texas Health Science Center at San Antonio work at the clinic as part of a six-week community health education rotation.
Physician assistant students and nursing students from neighboring UT Pan American also rotate through the mobile clinic throughout the year.
"It is important for our students to see this patient population - they have a lot of medical needs that (the students) may never encounter," Dr. McNeese says.
Medical School fellows use the Houston telemedicine equipment to make educational presentation to fourth- and fifth-graders in the Valley. And nurses in Houston are able to give free continuing education courses to Valley nurses via the technology so that they may keep their licensure.
"The clinic and the accompanying technology demonstrate that you can treat patients with limited resources and can deliver good care under a variety of means," Dr. McNeese says.
Reprinted from UT-Houston Medicine