Delivering Health-Care Services to People ‘Where They Need Them’

Tuesday, August 16, 2016

Two University of Arizona College of Medicine – Tucson programs that bring health-care services to people in Arizona’s rural, underserved communities are reaching major milestones this year: the Mobile Health Program, launched in 1976, and the Arizona Telemedicine Program, which got its start in 1996.

Four decades of health care on wheels

In October 1976, what was then the UA Rural Health Office launched the Mobile Health Program (MHP) with Augusto Ortiz, MD, a UA family physician, as medical director. Dr. Ortiz and his wife, Martha Ortiz, who managed clinic details, took their clinic on wheels – an RV donated by a Tucson missionary and outfitted with two small exam rooms – to such tiny communities as the Yaqui Pueblo and Picture Rocks northwest of Tucson; Continental and Amado, south of Green Valley; and later into Cochise County. Some families were so poor that their homes lacked electricity and running water. But the MHP payment policy was then what it is today: Pay if you can, and if you can’t, you still will get care.

The Ortizes, with their staff and volunteers, including medical students and resident-physician, as well as trained community health workers, known as promotoras, encouraged communities to establish their own clinics. Clinics thrive today in Picture Rocks, Continental and Amado.

Dr. Ortiz died in 2006, but Martha, now 92, continues to serve on the advisory board that advocates and raises funds for the program.

How much of a difference does the program make? Martha Ortiz recalls the experience of a young woman who had four miscarriages, before becoming pregnant a fifth time. A friend told her about the MHP, through which she received appropriate prenatal care for the first time. She carried her fetus full term, then gave birth to a perfectly healthy baby boy.

“For many individuals and families, the Mobile Health Program is the only place where they can get health care that they trust,” said Ravi Grivois-Shah, MD, MHP medical director and associate professor in the UA College of Medicine – Tucson’s Department of Family and Community Medicine, which now oversees the program.

“There always will be the need for this kind of program,” he said, “so our goal is to make our program sustainable into the future.”

Since its grass-roots beginnings, the UA Mobile Health Program has received financial support from the UA, Pima County, non-government organizations and private donors. Recent grants from Delta Dental of Arizona Foundation, Arizona’s First Things First child-development program and the March of Dimes support prenatal care, well baby check-ups and preventive dental care for children and adolescents in Tucson and surrounding communities. Both Banner Health and the UA Department of Family and Community Medicine provide additional funding.  

“Family and Community Medicine is extremely proud of the Mobile Health Program’s service to our communities over the past 40 years,” said department head Myra Muramoto, MD, MPH. It also has enabled generations of medical students and other health professions students to experience the satisfaction of providing care to rural and underserved people. The Mobile Health Program truly brings together our department’s missions of service, teaching and community outreach.”

Two decades of long-distance health care

The Arizona Telemedicine Program is an international leader in the “virtual” delivery of health care and long-distance learning opportunities for patients, physicians and other health-care professionals.

But in 1993, the program was only an idea. Former state legislator Bob Burns, now a member of the Arizona Corporation Commission, learned about the benefits of telemedicine at a conference in Scottsdale that year. He presented the idea for a telemedicine pilot program to fellow legislators and then-UA College of Medicine Dean James E. Dalen, MD, MPH.

Dr. Dalen embraced the concept and appointed Ronald S. Weinstein, MD, as director, a title Dr. Weinstein still holds. The Arizona Legislature authorized funding for the Arizona Telemedicine Program (ATP) in June 1996. In July 1997, the program went live with its first two sites, Mariposa Clinic in Nogales, Ariz., and the state prison in Yuma.

One of the early cases at the Nogales clinic, now known as Mariposa Community Health Center, was that of a little girl with a serious viral infection. Her doctor was consulting with UA professor of pediatrics Ziad Shehab, MD, an infectious disease specialist. The little girl and her mother – who did not have a car – were in the room, and at the end of the consult, Dr. Shehab said to the child, “I’m so sorry I can’t give you a hug.”

The girl walked over to the monitor and gave it the biggest hug she could.

The child now is an adult – a tribute to the advances in viral disease care, to which Dr. Shehab is a widely recognized contributor, and the convenience of telemedicine, which made it possible for the girl to be seen by an expert.

In 2003, the ATP established the T-Health Institute in downtown Phoenix, to offer training programs and videoconferences on innovations in education and health-care delivery.

ATP now is connected to 170 sites throughout Arizona. Specialists in a wide range of fields – trauma surgery, newborn intensive care, stroke diagnosis and care, ophthalmology, cancer treatment, burn care, behavioral health care and other specialties, as well as primary care – consult with their colleagues in almost every rural community in the state.

Outside the United States, ATP has helped establish telemedicine programs in Albania, Kosovo, Africa and Panama, and is exploring opportunities in other countries.

ATP has been recognized with numerous honors. In May, the U.S. Distance Learning Association honored the ATP for its “distance learning” sessions that physicians and other health-care professionals can log onto from around the state. The association’s highest individual award went to Bob Burns.

Asked if he had any idea 20 years ago what telemedicine would look like today, Dr. Weinstein said, “We would have recognized that in a decade the world would be very different. We just wouldn’t have been able to say precisely how that would be.”

Working together

Over the last 20 years, the Arizona Telemedicine Program and the Mobile Health Program have collaborated to provide eye care, prenatal care and other services to residents of Southern Arizona.

In 2004, the Arizona Department of Health Services and other funders awarded grants to ADVICE – the Arizona Diabetes Virtual Center of Excellence. The grants enabled the Mobile Health and Telemedicine programs to provide diabetes care, risk assessments, nutrition counseling and classes led by a certified diabetes educator to underserved communities ranging from Tuba City on the Navajo Nation, to Nogales, Ariz., where the Mariposa Community Health Center is located.

Mariposa’s team of promotoras helped diabetes patients understand their disease, made sure they got to their appointments, and helped patients connect with food banks and other services.

ATP’s distance-learning program made it possible for individuals around the state to learn from experts how best to live with diabetes – or prevent it from happening to them.

“I want to congratulate both the Mobile Health Program and the Arizona Telemedicine Program, which fulfill one of the highest priorities of the UA College of Medicine – Tucson: to provide all Arizonans with the preventive care and treatment they need to live healthy, productive lives – regardless of their economic status or where they live, said Charles “Chuck” Cairns, MD, dean of the UA College of Medicine – Tucson.

“These programs meet the critical health-care needs of diverse populations throughout Pima County and all of Arizona. They prove that we can efficiently bring medical resources to people where they need them.”

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