A mobile health unit provides some wheels out of poverty
By John KellyWhen she was a young mother — struggling with her finances, dependent on public assistance — Sheannea Bobbitt used to take her sick children to a free clinic that was two bus rides away from their home in far Southeast D.C. When Sheannea arrived, she couldn’t help but notice how sad and desperate the place was, how surly the employees were and how, in turn, that seemed to make everyone there sad and desperate and surly.
“I hated taking the girls there,” she said.
Sheannea had grown up poor, though she didn’t know it at first.
“You don’t really know that you’re poor until somebody tells you,” she said. “You grow up with family values, good character and integrity, and you don’t realize that money is missing.”
Thanks to her mother, Sheannea had those things. It was just the two of them living together in public housing in a neighborhood that Sheannea says was “infested” with crack. She wanted a path out.
“This is where I am,” she would tell herself. “It’s temporary. It’s not where I’m always going to be.”
But the clinic was a reminder how far she had to go. It was not a nice place. It seemed to reinforce the patients’ poverty. Then Sheannea learned about a mobile health unit that would come to her neighborhood. The unit — basically a fully appointed doctor’s office on a truck — was operated then by Georgetown Hospital. Since 2000, the program has been run by Children’s National Medical Center.
“Historically, transportation and geographical isolation have been barriers to access to primary medical care,” said Rhonique Harris, the medical director of mobile health programs for Children’s. “There are pockets of isolation in neighborhoods where there’s a lot of poverty, a lot of crime. But ultimately the families are just trying to make it. Families like my family, like your family.”
I think this is a great leap forward in patient access to health care, especially among the impoverished. Usually, I imagine patient navigation as when patients are directed to their providers, but here, the providers are directed to the patient. Given that the providers are trained, perhaps the latter method of patient navigation is in fact the easiest method. For example, the poor might not be aware that they are ill, and/or lack the motivation to go see a doctor. But bringing the doctor to the patient, even if the truck is just strolling around the neighborhood, might be a source of motivation on its own. The next step in patient navigation may be to increase access to insurance, although I'm not quite sure how this could be done. Though insurance policies are largely determined by politics, how does a patient know what insurance is best for him or her? Do we need more people to explain insurance policies? Feel free to comment.