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Mobile Va. health clinic serves rural populationsBy: Kevin Miller
Doctors came and went from the physician's office next door to his pharmacy, some staying for several years, others only passing through briefly. Often, there was a rotation of physicians - a different doctor for every day of the week. There were lapses when there was no town doctor, just Lineberry's pharmacy. Then in October 1999, after about five years in the office, the town's only full-time physician closed shop, leaving Craig County without a health care provider. Craig County residents, like a growing number of people living throughout rural America, were once again doctorless. "When there is no health care in a rural area, everybody loses," Lineberry said. Administrators in Radford University's nursing program had been watching with alarm the exodus of doctors from rural Virginia, which began decades earlier but intensified during the 1990s. For several years, staff at Radford's Waldron College of Health and Human Services brainstormed ways to bring the nursing school's services to parts of rural Virginia. In near-perfect timing, Radford received a federal grant shortly after Craig County's physician left town. Twice a week Radford recently wheeled out its temporary solution to a larger problem: a traveling health clinic that offers the New Castle area basic health care services. Twice a week, a crew drives the 36-foot converted mobile home through Route 311's winding Catawba Mountain pass to the New Castle public school complex, where it parks outside the elementary school until 4 p.m. The clinic treats only children on Tuesdays but is open to everyone on Fridays. A physician also recently set up a part-time practice in town. On a recent Friday, the clinic's nurse and nurse practitioners tested several children and one woman for strep throat and mononucleosis, treated a teen-ager with a sexually transmitted disease, administered allergy shots, checked on a 9-month-old boy who had previously been treated for an ear infection, did blood work on a woman, followed up on a woman with a lump in her neck, and performed physicals for two older men who hadn't been to a doctor in years. William Jennings had brought his 4-year-old son, Nathaniel, to the clinic for his allergy shots. Before the clinic opened, Jennings or his wife would have to find time out of their workdays twice a week to take Nathaniel for his shots. "It's very convenient to have it here because, otherwise, we would have to drive to Salem, and that's about 45 minutes in each direction," William Jennings said. The mobile unit's clinic is divided into three main areas: the main entrance, where visitors check in with the nurses and where most of the paperwork is done; a private room where patients fill out forms and talk with staff members before seeing the nurse practitioner; and an enclosed examination room with an examining table and all the gadgets - stethoscopes, blood pressure machines and an electrocardiogram - found in most doctors' offices. There's a wheelchair lift, and the mobile unit's bathroom readily converts to accommodate wheelchairs. Eventually, Radford officials hope to have a physician on board for some of the clinic's visits to New Castle. Until then, the family nurse practitioners call a consultant doctor in cases of serious illness and make referrals when needed. Most patients children The clinic has been offering its services for free, but Radford will begin charging and billing insurance companies soon. Fees will vary according to patients' ability to pay. Most of the clinic's patients are children. Because Craig County does not have much industry, many of the parents work in Salem or Roanoke. That means a parent with an afternoon doctor's appointment for a child would need to leave work from Roanoke to pick up the child in New Castle, drive back to Roanoke or Salem and then head back over the mountain to New Castle. The clinic could keep many parents from having to take off a half or full day of work. "We're so medically underserved, the children really needed this," said Lannelle Fisher, a full-time nurse for Craig County. The elementary school even helped advertise the clinic to parents of prospective kindergartners, who must receive a physical before enrolling in school. Bonnie Cranmer brought in her 4-year-old son, Josh, for his physical. But Cranmer, who works with several New Castle-area community organizations, hopes the Radford staff will use the clinic to help teach high school-age students about abstinence and safe sex. Cranmer said she is alarmed by teen pregnancy and the rate of sexually transmitted diseases in the area. 'A great opportunity' "I feel this is a great opportunity to address real problems, one-on-one, right here with these kids," Cranmer said. That's a possibility, Radford administrators said. A gift from the Scottish Rite Freemasons of Virginia will help pay the salary of a speech pathologist for New Castle's children. But in the meantime, the university is planning to take the clinic to other underserved areas of southwest Virginia. Radford received $264,000 to buy and equip the unit, plus an additional $1 million federal grant to cover operating expenses for five years. The Jesse Ball duPont Foundation also awarded Radford more than $200,000 for children's care during the next two years. "We hope to go to five counties in five years and then decide which counties need us most," said Janet McDaniel, coordinator of Radford's clinical programs. But McDaniel and other Radford staff are quick to point out that the clinic is only a temporary fix to a much deeper problem: Rural counties need full-time doctors. "It's not a permanent solution, although we have made a commitment to Craig County for as long as we are needed," McDaniel said. "But we cannot be there 24 hours a day and be their primary care provider." As he has quite often in the past quarter-century, Line- berry, New Castle's pharmacist, is trying to persuade several doctors to set up practice in the small mountain town. One doctor is working part time in New Castle, and Lineberry hopes he or other doctors will move in full time. There are plenty of health care needs to keep a full-time physician and Radford's clinic busy, he said. "There's a super opportunity here," Lineberry said. "I think the mobile unit provides a good service, and I think we need it."
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