Mobile units target high-risk groups
Education, testing, treatment help curb diseases
To reach segments of the community most at risk for the spread of infectious disease, St. Joseph’s Mercy Care Services in Atlanta put three of its clinics on wheels.
Its health care workers now travel to homeless shelters, housing projects, soup kitchens and jails to meet the needs of people most at risk for such infectious diseases as tuberculosis, HIV, and other sexually transmitted diseases (STDs).
While their approach to health care is holistic, a major part of outreach attacks infectious disease with education, screenings, and treatment. Often, the health care teams target an area of the community after a health department alert.
"We work with the health department to target particular areas. If they have a housing community that is showing an alarming incidence of anything in the STD area, then we will work with the health department to do a blitz. We’ll go out and set up in that community and try to get everybody into education and testing," explains Mary Hood, MBA, clinic director for Mercy Mobile Health Care.
In addition, 20 mobile clinic sites are serviced on a regular schedule each week. One site is a K-Mart parking lot in a community with large Hispanic and Asian immigrant populations. Another is a downtown church with a soup kitchen that serves 300 people. A health care team made up of a nurse practitioner, a social worker and a patient educator spends six hours in each location providing primary care, health screenings, and education.
The program began in the mid-1980s in response to homelessness with a few volunteers working out of a small van. In 1988, the group applied for a grant and purchased its first 40-foot custom-built mobile medical unit. "They wanted to offer more primary care services and to have the privacy to do more in the area of infectious disease," says Hood.
Now Mercy Mobile Health Care has three coaches each costing about $150,000 and two fixed-site clinics. Two-thirds of its $7 million budget comes from grants and private donations and one-third is from St. Joseph’s Mercy Care Services. Much of the work, particularly at the unscheduled clinics, is done by professionals who volunteer their services on Saturdays and evenings. From January to October 1996, professionals, including both physicians and pharmacists, donated 13,000 volunteer hours, says Hood.
TB prevention program
A major focus of the health care teams has been the HIV/AIDS population. Efforts include sending street teams into communities at high risk for HIV/AIDS infections to work with people one-on-one. Teams bring packets of culturally appropriate and gender-specific information. They also accompany the mobile units to night shelters and jails to provide group education, while others screen for HIV and STDs.
Another important component of the mobile units is a TB prevention project in which a health care team target areas of the city that have the highest risk for tuberculosis, including shelters, crowded housing, and high concentrations of immigrants. "We go out and test on a regular basis in those communities," says Hood.
It is difficult to measure outcomes of such communitywide efforts when a portion of the population is transient, Hood says. In some areas, the mobile units have a 90% return rate for treatment, but often much of the jail population disappears before the results from tests have come back from the lab, she adds.
One encouraging development is the fact that prevalence of HIV in the local homeless population has dropped from about 9% to around 5%, Hood says. Mercy Mobile Health Care must get some of the credit for this, she says.
[Editor’s note: To contact Mary Hood for more information on Mercy Mobile Health Care, write: Mercy Mobile Health Care, 60 11th St. NE, Atlanta, GA 30309. Telephone: (404) 249-8102.]
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