New mobile clinic takes primary care on the road to the state’s underserved populations.
    By Michael Staton

The attention Laura Soto paid to her health kicked into overdrive when she was diagnosed with diabetes two years ago. With unreliable transportation, no health insurance and a lack of fluency in English, she experienced an understandable level of frustration moving from clinic to clinic just to get blood work done, let alone get a clear sense of a way forward with her health.
Luckily for her, help came in the form of the Clemson University Joseph F. Sullivan Center. The Sullivan Center staff performed the requisite blood work, and the center’s translator and health coach helped Soto understand what steps she could take to improve her health through diet. She said she was spoiled by the staff. “The Sullivan Center provided me with a lot of good information that was easy to understand,” Soto said through a translator. “Since my first visit, my diabetes has improved, and I’ve gotten used to all the excellent people; I don’t want anyone else to draw my blood now.”
The best part, according to Soto, is that these services came to her in Walhalla. She received those screenings, along with a mammogram and Pap smear, through the Sullivan Center’s mobile clinic. She was skeptical at first of receiving care from a mobile clinic, but the results made her a believer.

Unveiled in November 2016, the Sullivan Center’s new mobile health clinic allows the center to effectively reach underserved communities and demonstrates to Clemson students the unique challenges in the care of vulnerable patients like Soto. Paula Watt, director of the Sullivan Center, has seen the center go through two previous mobile clinics since her arrival in 1996, and the Sullivan Center has operated mobile clinics for more than 26 years.
This iteration is anything but ordinary. The new clinic is the world’s first to operate completely off of solar power when parked, and it includes a variety of other features designed to optimize mobile health delivery. According to Watt, the new, one-of-a-kind vehicle that is larger, more efficient and more versatile allows the center to reach underserved communities more effectively.
“We did immeasurable homework on what we wanted, because the clinic is a rolling billboard for Clemson University and the outreach it provides,” Watt said. “This vehicle is truly a dream come true for me and our staff.”

Click to view video from a mobile device.

  • The height of mobile medical technology

The clinic is the most ambitious project to date for Odulair, the mobile clinic’s manufacturer, which has built dozens of mobile clinics for other organizations such as the Mandela Kids Foundation in Africa. Watt worked closely with Anita Chambers, president and CEO of Odulair, to create a unique, durable design for the clinic, and Chambers more than delivered.
One of Watt’s primary concerns was the clinic’s off-road capabilities to allow them to provide care to farmworkers on-site. Odulair started the project with a four-wheel drive base so that the clinic could tackle almost any terrain. It runs off of a diesel engine, but the drive base is such that a special license is not required to operate it. Wi-Fi connectivity is also improved over previous units, both in reliability and security in handling patient medical records. Due to spotty connections with previous clinics, staff had to sometimes create records with pen and paper that would be entered electronically upon their return to the Sullivan Center.
When parked, the clinic draws 100 percent of its power from a special solar battery system, which eliminates the noise and fumes from a traditional generator and decreases operation and maintenance costs. According to Chambers, it is the world’s first mobile clinic to incorporate 100 percent solar operations. “I think we’ve all dreamed of using solar power in this way for a long time, but the technology is finally at a stage where it can be useful,” she said. “Mobile clinics are required to sit in farm fields or other remote locations for eight or more hours a day, so the use of solar power is a huge improvement.”

For staff members on board the clinic, the many technological features may pale in comparison to something comparatively simple: space. The clinic features flexClinic™ technology, so that its walls move and convert the main clinic into a space composed of anywhere from one to five rooms. The clinic can be used as one large patient education room that fits 20 or a combination of rooms that serve lab, reception and exam room needs.

Megan Kyle serves as lead nurse practitioner on the Sullivan Center’s mobile clinic, and with previous experience on the last mobile clinic, she immediately saw the benefit to having more space. An extra exam room means nurse practitioners can see more patients, and flexible walls offer more patient privacy.
“Cramped conditions might help us forge a personal connection with patients a little quicker,” Kyle said, “but more space will allow us to see more patients and make them feel less like they’re on an assembly line.”

  • Empowerment through health education

According to Watt, the Sullivan Center uses the clinic in Greenville, Oconee, Pickens and Anderson counties as well as across the state to serve more people than ever before and provide valuable educational experience to Clemson students. Watt said the student learning impact has included more than 8,000 recorded hours of one-on-one teaching with Clemson nursing and other allied health students in 2016 alone between the old and new mobile clinic.

Meagan Huff, a senior in Clemson’s public health sciences department and intern at the Sullivan Center, is one of many students who was first exposed to population health and mobile health through the Sullivan Center’s clinic. Huff handles check-ins, blood tests and urinalysis, and she delivers health assessments to patients before handing them off to nurse practitioners.
While the clinic meets some immediate needs for patients, another program provides breast and cervical cancer screenings and connects them to a regular health care provider. However, the “lifestyle medicine” component that the clinic offers is arguably the most powerful tool at its disposal. Huff and other students have the opportunity to educate patients to manage physical activity, stress and nutrition. These messages are echoed through the large television screen attached to the clinic that provides interactive education tailored to the audience.
“I wanted to be as hands-on as possible with patients, and the mobile clinic gives me a less structured, more real experience out in the community,” Huff said. “Because of this experience I know I want to become a nurse practitioner so that I can continue to work with underserved populations.”
Both Kyle and Huff admit that before their experience with the mobile clinic, neither realized that an outreach service like this existed or that it was even needed. Kyle was first exposed to mobile health as a graduate assistant at the Sullivan Center before coming on full time as a nurse practitioner. Her previous experience was in traditional health care systems.
Kyle said the mobile clinic has defined her career. She became a nurse practitioner on the Sullivan Center’s previous mobile clinic. She learned how to drive it. She learned to speak Spanish on it. She learned how to effectively jump a diesel generator off of a gas engine. She “fell in love” with rural population care on it, but most importantly she learned what she wasn’t able to do in previous positions.

“The mobile clinic now has me thinking back to the patients I sent out into the world with chronic diseases they had no idea how to manage,” Kyle said. “It’s no wonder they ended up back in a hospital system with the same issues.”

Access to care is not the only issue this new unit can address. Access to quality food is a key component to improved health outcomes. Odulair equipped the new unit with food storage baskets that allow cooperative demonstration projects to provide fresh fruits and vegetables. When this concept is married to nutritional counseling, it not only allows the team to talk about the importance of having fresh food in one’s diet, it allows them to deliver the food on-site.

“We’re equipping people to take care of themselves in the long term,” Watt said. “When people take charge of their own health, the provider’s job is easier, and there is a higher likelihood of successful prevention, treatment and management if and when a major medical need arises.”

Westminster native Patricia Harris was ready to make a change in her life to improve her health, but a lack of insurance meant she was lost in a sea of patients at free clinics. When AccessHealth SC referred Harris to the mobile clinic, she wasted no time making her way to a scheduled stop in Oconee County. At the time, she had multiple health problems, including diabetes, high blood pressure, arthritis, high cholesterol levels and weight management issues. She stepped off the clinic after receiving a full physical and blood work with a diet plan and education on why she should follow it. The Sullivan Center staff even removed some questionable tissue from her back to send off for testing.

Harris said any doubts she might have had about the mobile clinic were erased the moment she left the clinic. Within two months, Harris lost 30 pounds on her new diet. Her diabetes and blood pressure medications were cut in half. Sullivan Center staff followed up with her to report that the tissue sample was not cancerous. The clinic pulled into a parking lot near Harris and changed her life.

“What the Sullivan Center did for me and how they treated me was better than any health treatment I’ve gotten at any doctor’s office in over 60 years, and that’s a lot of doctors’ offices,” Harris said, laughing. “I’m on Medicare now, but I plan on visiting the mobile clinic when it’s around. I’d rather see them and be treated like a person than go to a hospital.”

  • Regional and state impact one patient at a time

The new mobile health clinic was made possible by state support led by South Carolina Senator Thomas Alexander. Alexander regularly champions outreach and access to care for underserved populations, and he said he hopes the Sullivan Center can become the model for other organizations that wish to pursue the evolution of health care through the empowerment of individuals.

Alexander made clear that support given to the Sullivan Center was based on its track record of service and its longstanding emphasis on the importance of access to care. He feels that mobile clinics will continue to provide evidence-based data that proves they are an essential component of effective health care in areas of the state that are often underserved. “It’s critical that the state make it possible for organizations like the Sullivan Center to bring health care to folks who need it most,” Alexander said. “The state should support any mission that leads to better health outcomes, and the preventative and educational components provided by mobile clinics have proven time and again to do just that.”
According to the Mobile Health Map, a research network composed of organizations that run mobile health clinics, there are an estimated 2,000 mobile clinics located across the country. Data from many of those clinics reveals that mobile clinics provide accessible care at a cheaper cost to health care systems than emergency department visits; the group estimates that each mobile clinic results in 600 fewer emergency department visits every year.

Mobile clinics serve mostly uninsured, minority populations in both rural and urban areas. On average, mobile clinics save 65 quality-adjusted years of life during every year of operation. Each patient served saves an average of $1,600 in health care-related costs due to health education and prevention.

The patients aren’t the only ones benefitting. Health care systems enjoy more “bang for their buck” with mobile clinics. The Mobile Health Map reports that an analysis on return on investment for mobile clinics shows that for every $1 spent, organizations save $12. Jennifer Bennet, co-founder and director of the Mobile Health Map, echoes Watt’s statement regarding the lowered cost to health care organizations and the higher likelihood of successful treatment for those treated at mobile clinics. “Our research has demonstrated that mobile clinics have broad benefits for both clients and health care systems,” Bennet said. “More than half service rural areas, 14 percent exclusively so. These clinics provide care to nearly 4 million people each year.”
The proven benefits that mobile clinics have had across the nation are why Alexander doesn’t want the Sullivan Center to limit itself to four counties. Watt said she and her staff are ready to take that mission and literally roll with it, preferably up a steep hill or down a muddy path upon which no other mobile unit can reliably tread. Odulair claims the clinic should last well past 2030, and Watt said the Sullivan Center looks forward to making it a second home for years to come.
The staff is planning a “clinic campaign” as far as the Lowcountry. According to Kyle, the idea is to drive the clinic to a rural area in the Lowcountry and let the staff work its way back to Clemson over the span of several days.
Kyle said she is sure she’ll have to explain the clinic’s presence to health care organizations during the trip. She’s had to defend the clinic in the past to those who think it’s there to “poach” patients. Patients like Soto and Harris aren’t being poached so much as they’re being discovered so that organizations like the Sullivan Center can improve their odds when they reach these hospitals. These health care organizations usually come around when they realize the Sullivan Center is actually sending them brand new, health-conscious patients, she said.

“We treat and educate patients who don’t exist in any health care system,” Kyle said. “We take care of the immediate needs and put them on a path to better health. We don’t steal patients; we reveal the invisible ones.”

Michael Staton is a public information coordinator for the College of Behavioral, Social and Health Sciences and the College of Education.