We’ve touched on utilizing mobile clinics a few times in the course. For the most part, we discussed it in a US context, but this could hold true for other areas of the world that have the quality of infrastructure that is required for an automobile.
In Beatrice’s presentation, we talked about utilizing mobile clinics on the reservation for American Indians. The wide and vast acres of land in AZ may require providers to meet women in their location for prenatal visits. An Emory alumna once told me that she likes to “meet patients where they’re at”. She meant this in terms of knowledge about their health, but I think this is equally as important in the literal sense. In Eric’s presentation of urban vs. rural care, we saw that mobile clinics can be helpful as well. I believe the example we saw was primary care provided to a rural W. VA community. In our MCH Safe Motherhood Malawi example, it was important for the nurse to gather in the village so the women could ask questions. Another example of mobile clinics–my best friend from college does breast screenings on a bus that also provides mammograms to women in 4 boroughs of NYC. In all these cases, you are bringing necessary care to the people that need it.
With respect to birth, I think prenatal visits are completely feasible and realistic for these American Indian populations or anyone else who may live in a very rural area. Similar to what we saw in Eric’s video, the visits can include disbursement of medication like prenatal vitamins and such. Mammogram and screening type appointments are also appropriate. What is the solution, though, when a woman gets further along in her pregnancy? What if complications occur between visits? Whose responsibility is this/shoulders does this fall on? In our society of finger-pointing, I think having mobile clinics can actually be very risky. I would hate to see the provider saying s/he left the woman in good condition and the woman saying why didn’t s/he catch this problem when s/he saw me? Also, what if the mobile clinic is bringing important medications to people and doesn’t make it out to the community for some reason? That can be life-threatening. I know IHS currently only collaborates with certain pharmacies, but perhaps getting a contract with a company like Express Scripts who delivers to the door might help and decrease gaps in medication.
Obviously, the best idea would be to build a clinic in these communities and convince healthcare providers to be there 2-3 or even 5 days a week, but what can we do in the interim that is not so risky? And in the interim with our mobile clinic prenatal visits, what would happen when it comes time for a woman to deliver? I’d like to see what people think out there, because I have been contemplating on this for weeks now and still haven’t brainstormed of any good ideas.
I completely understand the dilemma you are facing in thinking about this question, and I’m really glad you wrote about it because I have been pondering on it too. Mobile clinics obviously do play an important role in providing access to care that individuals in these areas probably would otherwise not receive. But it does create a dangerous precedence that may lead to the idea that a mobile clinic is enough care for individuals in these areas. It may then impede the construction or organization of a more permanent clinic or hospital in areas of high need. That being said, I really do think that mobile clinics are a good TEMPORARY solution for providing care. In comparison to building and staffing full clinics in every area of high need a mobile clinic is less expensive and allows for one team to travel and provide care. Mobile clinics are extremely useful for basic services, screenings, scheduled delivery of medications, and quick prevention activities such as immunizations or handing out contraceptives. Like your friend in NYC that does breast screenings in a mobile clinic, I know of some HIV/STD clinics in Atlanta that use mobile clinics for testing and treatment services in areas where people may not have a clinic nearby. In this case the mobile clinics are providing health knowledge for the individuals giving them some amount of control over their health outcomes. But in the case that someone does test positive for HIV, the mobile clinic no longer satisfies their health care needs and referral to a long term care center is necessary for that individual to access medications and treatments. For this reason a mobile clinics is probably most useful when it is part of an integrated health network where referral to a hospital or long term care center is possible.
Obviously this type of referral is not always possible, or there would probably not be as much of a need for mobile clinics. This makes me think that mobile clinics use and funding should be contingent on a long term plan (say five year plan) to make a hospital or health clinic that is easily accessible in that area. The mobile clinic can then serve as an interim health care source and the health team could train people from the area/recruit professionals that can later staff the clinic. The mobile clinics could also provide education for community members by hosting courses that could cover topics such as nutrition, safe birthing and motherhood, sex education, and health literacy. This could in the very least provide a knowledge base that people could use when the clinic was not around, and health literacy courses would help empower communities to advocate for better health care access. The most important thing in my opinion is that patients make some type of contact with healthcare staff that can support and comfort them. This contact would ideally provide them with later contact to long term care solutions.
Thank you for your post, Chau. I enjoyed reading it, because I have had many thoughts about the class’s suggestions of mobile clinics.
Last year, I competed in the Global Health Case Competition at Emory. The case required me and my team to propose a solution to a global health problem in the world. We suggested the implementation of mobile clinics for many of the same reasons that you mentioned. For example, the mobile clinics would provide health services to people in rural areas who cannot access healthcare elsewhere. In addition, the mobile clinics would serve as a preventative measure as well, for they could conduct check-ups, or mammograms as you mentioned. However, despite our pitch on the benefits of mobile clinics, our judges, including former CDC director Dr. Jeffrey Koplan, shot down our idea for various reasons. To begin with, as Brenna pointed out in her response, many obstacles arise from the use of mobile clinics. For example, mobile clinics prevent continuity of care. Thus, a mobile clinic may leave an area one day after notifying an individual of a positive test or screening for a disease or illness. As a result, not only will the individual not receive care, but also he or she may experience negative mental health effects from the realization of future suffering. Therefore, one can argue that “not knowing is better than knowing of an illness and the inability to obtain treatment”. In addition to continuity of care, issues with sustainability exist with the utilization of mobile clinics. For instance, people in the target areas may begin to rely on the mobile clinics’ visits throughout the year instead of seeking out medical services or care on their own, especially if the mobile clinics provide free services. Therefore, as you mentioned, mobile clinics should supplement a permanent medical facility rather than replace it. Moreover, however, mobile clinics create other issues with sustainability as well. For example, mobile clinics require staff and fuel. Thus, if a NGO or other external organization provided the mobile clinic, then the clinic will require future funding to continue to function, often not solidified when donating the clinic. Therefore, we should not immediately jump to mobile clinics as the “golden” solution to providing healthcare in delay-stricken areas.
Thank you both for your thoughts! I think we are all definitely on the same page in our thinking that mobile clinics cannot serve as a permanent solution to healthcare. They are definitely supplemental or stop gap/interim measures. In fact, I think in some cases they can be considered an ethical dilemma because of exactly what you guys mentioned. Should someone test positive for HIV/AIDS or need further prenatal care, what responsibility does the mobile clinic and its workers have next? It is important for both patient and provider to play their parts in a patient’s care, but is it really enough to simply refer someone to a different place for adequate care? I guess that’s the next question in this series.
1) We understand mobile clinics cannot serve all people’s needs. They should serve as temporary places of care.
2) Since they are temporary places of care, what happens next when someone is identified as high-risk pregnancy or positive for a disease/disorder?
3) Is it really enough to provide a referral? Let’s think about the American Indians or rural-living citizens globally who have extra barriers between them and this referral spot.
4) What can we do as providers, lay global citizens, or head honchos to facilitate a person’s attendance at this referred site?
I only say this because I’ve seen one too many times (from work experience) of people “dropping the ball” on things because other barriers were present–the facility was too far (time and transportation issues), facility hours didn’t mesh with my schedule (I work too much), it wasn’t on the MARTA line (no car). I know here in ATL or the US, we can simply refer to another place…but what happens in a global setting when referral sites are far and few between?
Chau, Brenna, Amy, all of you raised really interesting aspects of mobile clinics that I have never thought of. At first, mobile clinics to me seemed like a viable solution to rural areas. However, after reading your posts, it has made me question the efficacy of a mobile clinic. I even did a quick google search to see if any studies were done to show the effect of mobile clinics. In the first article I read it examined the effect of mobile clinics with treat veterans.
One of the limitations mentioned were similar to what was raised earlier, was that the mobile clinic was only sufficient for basic care and was not able to provide thorough diagnostics since the vehicle wasn’t equip with the machinery necessary, such as an X-ray machine. The other limitations that were listed dealt with financial limitations to keep the mobile clinic running. In essence, mobile clinics were not seen as a long-term possibility in replacement of regular check-ups at a clinic. However, it is a possible solution for a more focused health need such as dentistry. The tools needed for a regular check up with a dentist is much less compared to a health check-up.
Nonetheless, mobile clinics are not sufficient for the needs of a high-risk mother or patient who has tested positive for a disease. With referrals to other facilities, the patient faces even more barriers to reach the adequate health care they require. In regards to getting the patient to the facility, it might be possible for the facility to offer transportation to their clinics. I am not sure how the finances would work out in this situation. However, it would reduce the transportation barrier. Just as special transportation is provided to those who are handicapped, a similar service could be provided to those struggling to reach health care facilities that are in reach by public transportation. We often read about how incentives are offered to help persuade the patient to do x, y, or z. This same system could be used with coming to the facility. The exact incentive should be determined by the community needs and what is deemed needed the most.
Personally, I feel that our society is always striving for a quickest and fastest fix to any solution. However, health is so complicated that this model of a “quick fix” cannot apply. Mobile clinics offer a medium in between no healthcare and the hospital and should, as other have mentioned, be used as a conjunction to the hospital, not replacement.
this was the link to the research studied mentioned above. http://www.biomedsearch.com/article/Evaluation-VA-Mobile-Clinics-Demonstration/61792311.html