Patricia1 arrived early for her breast and cervical screening and found the Ohio University College of Medicine’s (OU-COM) mobile clinic staff working out of a “traditional” physician’s office. Normally she would meet the staff on the 40-foot mobile van, but the generator quit working shortly after the van arrived in Pike County leaving the staff with no lights or air conditioning. The van was strategically parked by the county health department and a local physician’s office, the latter of which generously agreed to provide an examination room for the rest of the day. The setting for the clinic shifted mid-morning; yet, the nurses’ performances seemed quite fluid, the disruption barely noticeable in terms of its impact on how the nurses provided care. Janice Smith, Certified Medical Assistant, greeted Patricia warmly, and proceeded to take her blood pressure and temperature and review her health history and contact information. After briefly conferring with Janice, Melanie Moynan-Smith, C.N.P., introduced herself to Patricia, reviewed her medical history, and asked her about her primary health concerns. Melanie patiently listened and worked to put Patricia at ease before she began the physical exam. Patricia seemed to benefit from this holistic approach to healthcare. As it turned out, Patricia was facing a probable sheriff’s sale of her home in a few days. Likewise, she revealed that she had to sell aluminum cans to have gas money to get to her appointment and she might need to sell her vehicle in order to generate more income. Compounding all of her personal issues were new medical concerns revealed during the exam. Staff members worked in tandem to set up a referral appointment with a specialist in Athens for Patricia.   Was there transportation from her town to Athens? Could they secure a gas voucher for her? What other resources might be available?  The staff worked swiftly and with recognition that healthcare must be situated within the broader life circumstances of patients. (Observation Fieldnotes)

he mobile health clinic of OU-COM works diligently to provide free breast and cervical cancer screening services in ten southeastern Ohio counties in Appalachia, a region characterized by some of the highest cervical cancer mortality rates in the United States (ARC). The clinic serves uninsured and underinsured rural women aged 40 to 64. Staff members also provide health education in school settings, community agencies, and senior centers.  Like the broader region of Appalachia, residents served by the clinic generally have less access to health care due to fewer material resources, geographic isolation and a lack of transportation, and uneven distribution of health care providers across rural and urban settings.  The very nature of curbside care requires that staff members provide services amidst the shifting scenes of health care. Role performances by staff members unfold in turbulent and unpredictable settings, and reveal the importance of adaptation. Indeed, there is a distinctively improvisational quality to how care is provided, as staff members respond to situational factors (e.g., the van’s generator fails, the unavailability of phone services, the weather) in order to provide reliable care. As shared by Anne Perch, R.N., during an interview, “You know, it takes a lot to get that patient there. So, just up and canceling it, we may not have that opportunity to get that patient there again.” Staff members bring compassion and concern to their work as care providers for women in convenient and accessible settings.

Leslie arrived for the last afternoon appointment of the day. She, too, met with Janice for the routine intake process. “When was your last pap exam?” asked Janice. Leslie indicated that it had been at least two years, elaborating that she had an appointment with her doctor for an exam last year but had to cancel it because she could not afford it. As she stated, “I had to choose what to pay for and that lost.” Leslie then went on to say she was grateful for the clinic because she knows how important these exams are for women. (Observation Fieldnotes)

The mobile clinic reaches many women like Leslie who might otherwise forego critical breast and cervical screenings. Additionally, women served by the clinic are able to obtain a voucher for an annual mammogram as recommended by current American Cancer Society guidelines. In addition to administering pap tests and breast exams, the staff members frequently address other health concerns that may require attention such as diabetes, depression or the effects of smoking which are common to the region (Denham, Meyer, Toborg, & Mande, 2004). Education also remains a critical task of staff, whether they illustrate how to perform a breast self exam, offer smoking cessation tips, provide information about healthy lifestyle habits, or share dietary information with youth attending regional high schools. Staff members sometimes offer examples from their own lives as a way to relate to and connect with their patients. For example, we have witnessed staff sharing personal experiences with smoking cessation and empathizing with patients who are trying to quit. In order to ensure that patients are able to access future health facilities, those who require follow-up care of any sort are referred to local physicians or clinics. In many cases, the OU-COM team arranges for follow-up appointments on behalf of the patient, especially when the patient may not have access to a telephone. Additionally, following an exam, patients are provided with brochures to help with information retention and comprehension.

The OU-COM Breast and Cervical Screenings are funded in part through the Columbus (Ohio) affiliate of the Susan G. Komen Breast Cancer Foundation and the Ohio Department of Health Breast and Cervical Cancer Project. We have participated in several clinics over the past two months, traveling 169 miles and observing approximately 30 hours of interactions between staff and clients. We have been witnesses to the incredible care and compassion that staff members bring to women of the region whether they are working in Athens or 75 miles away in Pike County. By providing reliable and quality care amidst shifting scenes, the OU-COM mobile clinic contributes to the well-being of women in the Appalachian region of Ohio.

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

October 1^st, 2005

References

Appalachian Regional Commission (n.d.) Health. Retrieved September 10, 2005,

from http://www.arc.gov

Denham, S. A., Meyers, M. G., Toborg, M. A., & Mande, M. J. (2004) Providing Health Education to

 Appalachia Populations. Holistic Nursing Practice, 18(6), 293-301.