In Appalachia, barriers to healthcare include distance from a provider, lack of transportation, lack of health insurance, and the inability to take the time off of work to drive, wait and be seen. So throughout the region, mobile health units are attempting to bridge that gap and bring services to some of the populations that need them the most.
Outside of an old train station in southwestern Virginia, Teresa Gardner and Paula Hill-Meade are seeing patients.
“What we’re doing now is kind of reviewing a couple patients that came in this morning," says Gardner, executive director of The Health Wagon, a mobile health unit that provides primary care to underserved Appalachian populations. "This gentleman, he has been in the recent coal mining layoffs.
“We are down to less than 100 coal mining jobs in Wise County,” she says. “The coal mining industry has just been devastated. There used to be thousands of jobs in the area and now it’s reduced to less than 100.”
Gardner says the miner’s family had been able to get insurance through the Affordable Care Act, but that it was costing them more than $1,000 a month.
“They were wanting to get established with us because they knew they wouldn’t be able to continue affording that,” she says.
Paula Hill-Meade is the clinical director of the Health Wagon. She says when they first started, they almost exclusively saw people without insurance.
“But now we’re seeing a lot of people with high co-deductibles of some $3,000-$4,000. So it’s really catastrophic insurance because how do you pay out $3,000-$4,000?” says Hill-Meade.
In 2013, the latest year for which data are available, the Health Wagon assisted more than 11,000 patients at 11 southwest Virginia sites. These are often really sick people who either don’t have insurance at all or can’t afford the insurance they have.
“Not a day goes by that patients’ lives are not saved here,” says Gardner. “They come in with various co-morbid conditions, like diabetes, obesity, heart disease or lung disease.”
One of those people is a young woman named Mary. We withheld her last name to protect her privacy. Like almost a million other Virginia residents, she doesn’t have insurance, although she says she should get it in the next couple of months. She started using the Health Wagon about six months ago.
“They’ve really helped me get my diabetes under control, which I wasn’t aware that I had it, so I really don’t know where I would be in the last six months as far as health-wise,” says Mary. “I probably would be in a lot worse shape than I am now.”
The Health Wagon asks for a $10 donation from patients if they have it. But if not, services are free. They are able to provide these services at a free or reduced cost to clients like Mary because the Wagon closely collaborates with universities and organizations around the country, such as The University of Virginia Health System and The Virginia Healthcare Foundation.
Hill-Meade says The Health Wagon takes a holistic, multidisciplinary approach to healthcare. Partnerships with labs, pharmacy schools and universities allow them to provide specialty consults through telemedicine services and tests at free or reduced cost. The vast majority of the population that uses their services are working poor adults. Most of the children in the area qualify for Medicaid.
“We’re trying to address these healthcare disparities because we have higher rates of just about every disease process,” says Gardner. “I mean, we have higher rates of diabetes, have higher rates of mental illness, suicide…”
According to the Health Wagon website, compared with the rest Virginia: Health Wagon clients are 21 percent more likely to die from diseases of the heart, 14 percent more likely to die from diabetes, 40 percent more likely to die from unintentional injuries and 50 percent more likely to die from suicide.
“You know the economy is just kind of devastated here – I’ve been here in this clinic for 23 years and I’ve never seen it this dire for patients,” says Gardner. “They have to make daily choices between eating and paying electricity bill or medications and so on and so forth. We see that on a daily basis. And, unfortunately, people die without a health care access because of the economic factors that play into that.”
This year, in part due to the coal mining layoffs, they’ve had a waitlist for services. The Health Wagon just added a new nurse practitioner to try and meet the demand.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.