It was a sunny morning in July and the Healthy Adult Program (HAP) employees were setting up tables for their clinic in Logan County. Because this HAP clinic was held concurrent with the monthly distribution of food by a county-wide pantry and parking space was limited, the group had been unable to bring the mobile van bearing the logo of the Ohio University College of Osteopathic Medicine (OU-COM). Melanie Moyan-Smith, C.P.N, Janice Smith, and Anne Perch, R.N., set up for the blood pressure, glucose, and cholesterol screenings, targeted at the elderly who remain at risk for diabetes and other health concerns. Richard Shuler (a staff member of the clinic) and Geoff Osterland (a member of AmeriCorps/VISTA) set up tables to handle intake of patients. Richard unfolded a large green Ohio University banner and placed it across his table. Geoff placed brochures and flyers about health-related issues on his table.  Emma1 came to the clinic to have her cholesterol checked.  After completing the intake forms, Emma came to Janice’s station.  When Janice asked her if she was on medication for diabetes, cholesterol, or blood pressure, Emma said, “No. I used to be. I think it was Levicor. But I started feeling better.  And I kept hearing about the potential side effects on your liver, and it scared me, so I went off.” “How did you hear that?” asked Janice. “Primarily TV.” Janice quickly responded, “Emma, I encourage you to talk to your doctor.  Don’t let the ads scare you. Whenever a doctor puts you on meds like Levicor or Zocor, they watch the liver real close. So you don’t need to be scared. And, you should always go off meds with the doctor’s knowledge.” Janice checked Emma’s blood pressure, cholesterol, and glucose; her cholesterol was high—297. Janice gave Emma a form to take to the doctor and encouraged her to fast before she went so that the doctor could break down the various types of cholesterol to better diagnose the problem.  Anne pointed out, “Sometimes, when we do find something, it’s nice to be able to help people in that way.” At that point, Dr. Lynn Harter, an observer of the clinic’s activities, had her cholesterol checked! (Observation Fieldnotes)
 

he Appalachian counties of Ohio, like the broader Appalachian region, are characterized by  some of the highest rates of blood pressure, cholesterol, and diabetes in the United States (Demerath, et al, 2003; Smith & Tessero, 2005). Melanie, Janice, Anne, and Richard work diligently to detect and monitor these conditions.  By offering free clinics, the Healthy Adult Program (HAP) ensures that screenings are accessible to those most in need. Traveling with testing machines and intake papers, staff members set up clinics at community centers, schools, and health fairs. Funded by the OU-COM and the Appalachian Regional Health Institute, HAP is a mobile clinic that serves 10 Southeastern Ohio counties. HAP offers education and screenings for blood pressure, cholesterol, and diabetes, as well as breast and cervical cancer screenings, education, and referrals to uninsured women in the Appalachian region of Ohio. The curbside care of the clinic by its very nature defies contemporary understandings of health care settings. The settings of health care literally shift to the primary scenes of people’s lives: front-yards, churches, and parking lots. Staff members work to provide consistent and quality care amidst shifting scenes and in light of economic and social circumstances of people’s lives.

The populations served by the clinic have unique concerns that often prohibit them from taking full advantage of traditional health care including the inability to pay for services, geographic isolation and separation from health care resources, and the inability to leave work for appointments. During an interview Janice shared, “We reach a lot of low income and uninsured people and we specifically target places like the food pantries in order to reach this population.” With expanding the traditional settings of health care, the HAP staff works to ensure that under-served people have opportunities to receive reliable care.

Melanie, Anne, Janice, and Richard are no strangers to navigating the ambiguous terrains of mobile care. Improvisation is inherently embedded in what staff members do – it is woven in the fabric and texture of their daily lives. Although staff members usually drive to the screening sites in a clinic van and “pack as if going on a trip,” according to Melanie, occasions often arise that require quick thinking and resourcefulness.  Because of the mobile nature of the clinic, the members of HAP have to be able to manage unforeseen situations.  HAP staff members not only adapt to the space of the clinic, but they also adapt medical information so that all clients can understand the information. For example, in order to help clients understand the difference between good cholesterol (HDL) and bad cholesterol (LDL), the nurses tell clients to think about good as “happy” cholesterol and bad as “lousy” cholesterol, encouraging clients to use the letters to remember differences between types of cholesterol. Although the setting for the clinic is constantly changing, Melanie, Anne, and Janice remain able to make clients feel comfortable in temporary spaces.  Staff members educate patients even as they conduct screenings, often discussing health-related issues such as insurance coverage and prescription drug programs.       

The mobile clinic of the OU-COM was created to address unmet health needs among under-served populations. We have participated in HAP activities over the past four months, traveled over 167 miles and spent more than 50 hours observing interactions between staff and clients and talking with staff.  We have witnessed how staff members’ resourcefulness functions to provide quality care across diverse settings. Ultimately, the mobile clinic’s curbside care functions to disrupt material and geographic barriers to health care as it shifts the settings in which the provision of services unfold.  

Written by: Heather J. Carmack, Karen Deardorff, Pamela Kenniston, Elizabeth Rattine-Flaherty, and Dr. Lynn M. Harter of the School of Communication Studies, Ohio University

October 1^st, 2005

References

Demerath, E., Muratova, V., Spangler, E., Li, J., Minor, V. E., & Neal, W. A. (2003). School-based obesity screening in rural Appalachia. Preventative Medicine, 37(6), 553-560.

Smith, S. L., & Tessaro, I. A. (2005). Cultural perspectives on diabetes in an Appalachian population. American Journal of Health Behavior, 29(4), 291-301.