By EWA MATUSZEWSKI
I’m keeping with my community theme for this column, but this time, I’m taking it to the streets. After years of being a wish-list item, our organization is set to acquire a refurbished mobile clinic, thanks to generous grant assistance from Blue Cross Blue Shield of Michigan.
Mobile health clinics are not a new concept, and there are thousands of them in operation, but I suspect their value was somewhat diminished amid a decade of healthcare news on emerging medical technology, mega health system mergers and Wall Street takeovers of primary care. But again, we see the pandemic forcing us to reconsider how we deliver care, especially to the most vulnerable. Mobile clinics go to the heart of communities that are frequently shut off from convenient and accessible care. They also serve as a direct response to addressing the social determinants of health (SDOH). It was our organization’s immersion into SDOH issues that first piqued my interest in the mobile clinic; it was COVID-19 and the need to vaccinate the largest number of the population as we can, that moved it to the top of the list. (As an aside, I want to thank Dr. Richard Bryce, an osteopathic physician who is the Chief Medical Officer at CHASS Center and a faculty advisor for Street Medicine Detroit and Detroit Street Care, student organizations affiliated with Wayne State University School of Medicine and Michigan State University College of Osteopathic Medicine. The lack of a mobile clinic has never hampered his team’s tremendous efforts!)
The planned use for our mobile clinic is to amp up our vaccination efforts, but also to bring community health to the community for the inherent public health benefits such an endeavor brings. I offer a Good Humor truck analogy – for those who still remember them – but instead of bringing ice cream, we bring health care. I’m not sure if a bell will be installed, but we’ll use community resources and neighborhood networks to introduce the mobile clinic and encourage visits. While services will be covered by insurance for those who have it, there will also be complementary care for those who don’t. Such open access is critical to the success of mobile clinics in achieving their mission.
Pivoting the insurance topic over to our pop-up COVID-19 vaccination clinics, one of the memories that resonates most with me from our experiences in offering free vaccinations, no questions asked, is the disbelief of the recipients. While many of the thousands of people we vaccinated did have insurance (which we used for partial reimbursement of our services; the funding barely covers half of our expenses), those with no insurance, or even proof of U. S. citizenship, were never turned away.
Oh, to see the relief in the eyes of individuals who did not have to feel like second-class citizens based on their insured status! Indeed, it opened up communication for providers (from physicians to nurses to pharmacists and allied health students and beyond) to ask about their overall health and to educate them on how they could obtain care for various health ailments mentioned during the vaccination process.
It was not uncommon to field requests for a blood pressure check, which we were happy to do, or to respond to other medical concerns. These pop-up clinics were deemed neutral territory, an atmosphere we hope to replicate with the mobile clinic. This is a topic I touch on in the unconscious bias training program I developed with our team. One simply cannot not underestimate the feeling of being diminished or dismissed based on insurance status. While I don’t necessarily have a solution, the need for compassion and humanity must be emphasized to minimize any unfounded sense of unworthiness.
And, to end on a happy note, I brought in a pediatrician friend temporarily out of retirement to assist with several pop-ups. She was open to the ribbing I couldn’t resist when seeing how her early vaccination skills weren’t what I expected for a physician. She explained that pediatricians, who encourage and supply a plethora of childhood vaccines, often don’t actually administer them, because they don’t want children to fear their doctor – although it’s fine for them to fear the nurse or medical assistant, apparently! Alas, with a few extra training jabs, my friend was quickly an old pro. Maybe I can re-enlist her when we go mobile!