“This is the future of medicine,” says Dr. Trina Wiggins, a pediatrician who’s about to see patients inside Southwest Medical’s clinic on wheels. “You’ve got to bring the medicine to the people.”
She’s speaking to the fact that it’s not always easy or possible for people to access care, whether they lack transportation or hours in a day to devote to even the most basic health concerns. The majority of its patients have insurance, though roughly 1 percent of all those served in the past year were uninsured (no one is turned away).
While it’s hard to pinpoint the rise of mobile clinics in the country, Wiggins said in recent years she has seen an increase in innovative ways to distribute medical care, whether through clinics on wheels or even telemedicine kiosks. She added that Southwest Medical has looked at and implemented various approaches to reach more patients.
Today, its 45-foot-long Medicine on the Move unit (launched in April 2016) is parked outside the East Las Vegas Community Center, equipped to see up to 24 patients in a day before it rolls on. Wiggins says it rotates back and forth between Southern and Northern Nevada, parking at elementary schools, churches, community centers and nonprofit offices.
It contains two exam rooms mimicking a typical bricks-and-mortar doctor’s office (windowless view included), a radiology lab for mammograms and ultrasounds, and everything needed for immunizations, physicals and general checkups. It’s a model various providers in Nevada have adopted in the hope of reaching the underserved.
“A perfect example is a father of three we had who needed to get his children vaccinated but didn’t have a car,” Wiggins says. “He relies on public transportation and would have had to take three buses to get to his doctor’s office. Can you imagine getting three kids on the bus after giving them shots?”
Medicine on the Move also goes into rural towns, and administrators envision expanding into tribal areas and other isolated communities. “That’s priceless for those patients,” Wiggins says.
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Around 9 a.m. on a weekday, Touro University’s 34-foot mobile clinic enters the parking lot at Catholic Charities of Southern Nevada. It is staffed by seven physician assistants, including professor Joshua Owens.
His students set up a row of chairs for the people waiting nearby. One by one, they will be checked for pulse, blood pressure and temperature before being asked a slew of questions to determine what they need.
Some are homeless. Others are refugees still getting their bearings. And the clinic staff is prepared to address everything from upper-respiratory infections to complications from diabetes. Owens said that without Touro’s site visits, these health problems would go untreated.
“Many of these people wouldn’t go to the doctor until the crap is about to hit the fan,” Owens says. “Once it gets to that point, it’s usually too late.”
Phil Tobin, director of the School of Physician Assistant Studies at Henderson-based Touro, said this mobile clinic started about four years ago with this population in mind.
“These are the people who are slipping through the cracks,” he said. “Without health care, their only option is to use an emergency room.”
Once students have checked vitals and gathered medical histories, they escort patients inside the clinic’s two exam areas — the unit’s main space and a smaller, private room. In the main section, labeled cabinets are stocked with such essentials as ibuprofen, multivitamins, cough suppressants, splints, and even nebulizers for patients who are having trouble breathing.
One of the first patients of the morning is 57-year-old, Freddy Cavitt, who has been staying at Catholic Charities this week. Taking off his leather jacket, Cavitt plops down on the examination table. Along with problems associated with his diabetes, he has been having breathing issues.
“I’m going to listen to your lungs,” Owens says. “Take a deep breath.”
Owens hears some wheezing, but nothing too concerning. He is more worried about Cavitt’s low blood sugar and instructs him to take advantage of the free daily meal offered by Catholic Charities. At the end of the exam, the patient walks out with the standard care package of hygiene supplies, protein bars, aspirin and other basics. Touro secured a grant to help pay for supplies, fuel and insurance for the clinic.
If the PAs discover issues that require another level of care, they refer patients with nonemergent conditions to Volunteers in Medicine (which helps the uninsured) and send life-threatening cases to the emergency room. In both cases, Touro will arrange for transportation — by calling an ambulance or partnering with the agency the clinic is visiting to get the patient where he or she needs to go.
Beyond Catholic Charities, Touro regularly parks at Veterans Village and the Shade Tree, and a second unit run by its osteopathic medicine department works exclusively with special needs patients on the campuses of Opportunity Village. Touro tries to be consistent on the days it returns to each place so clients can expect to see them.
Tobin said there are plans to expand the coverage area, and talk of creating a third clinic to target rural populations.
He also said Touro is conducting an impact study to better track the number of repeat patients and further understand those patients’ needs.
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Given the wildness of Las Vegas, it might seem perfectly normal to glimpse a giant electric-pink trailer cruising the streets. But this one belongs to Nevada Health Centers, and it specializes in mobile mammography.
“We have the same accreditation and licensing as a free-standing, bricks-and-mortar location,” program manager Colleen Petrosky says of the Mammovan, which travels throughout the state to provide the scans that protect against unchecked breast cancer. “We just happen to be on 18 wheels.”
The van’s first room is a waiting area. Pink pillows that read “I’m a survivor” line the bench across from a flat-screen television, which plays stories from women whose lives have been impacted by the Mammovan. The imaging equipment is in the back. “We take digital images and transmit them to a radiologist, who can see them within 10 or 15 minutes depending on connectivity,” Petrosky says of how quickly results can be shared with patients.
If anything abnormal is present, staff can connect women with caseworkers to help with follow-ups.
The Mammovan launched in 2000, after former Nevada first lady Dema Guinn watched a relative die from breast cancer after having trouble getting screened. Recognizing the obstacles women might face, especially in rural areas, Nevada Health Centers created the clinic. More than 42,000 women have been screened since, with 3,677 in 2015 alone. (Even before this, in 1998, Nevada Health Centers had rolled out its Ronald McDonald Care mobile clinic to provide children with preventive and restorative dental care.)
“In some of the smaller towns like Hawthorne or Tonopah, they might have medical facilities or a small hospital,” Petrosky says, “but there is no imaging available.”
If it’s an issue of insurance rather than physical access, the Mammovan doesn’t turn anyone away.
“We had a lady from Pahrump screened in October 2015. She had no health insurance at that time but was able to get screened. She was diagnosed because of it,” Petrosky recalls, adding that the woman had stage II breast cancer and survived because of the screening.
The goal of medicine, wheeled or otherwise, is to provide such interventions when they really count. By bringing the care to the people and removing some of the barriers, mobile clinics tip the odds.
“This saves lives,” Petrosky says.