In Houston, inner-city elderly step aboard a 12-ton truck outfitted with the latest medical equipment that rolls right into their neighborhood.
St. Joseph Hospital operates the 40-foot mobile clinic as a way to bring basic healthcare services to those who are least able to travel to them.
Hospitals like St. Joseph are looking for innovative ways to fulfill their charity missions to their communities. Rather than waiting for the poor and the sick to come to them, they're taking the healthcare to them.
"We're going to the churches where these people pray and to the neighborhood centers where they go for social services," said Esmeralda Cervantes, the hospital's outreach coordinator.
Although no statistics are available on how many hospitals operate mobile clinics, anecdotal information indicates that hospitals are taking to the road in record numbers.
The largest national mobile clinic program, funded and organized by the Children's Health Fund, works through hospitals in eight cities ranging from New York City to Clarksdale, Miss. The fund was started by singer Paul Simon and Irwin Redlener, M.D., chief of community pediatrics at Montefiore Medical Center, New York.
A mobile program operated by Parkland Memorial Hospital, Dallas, is part of that program. With two $120,000 vans, the tax-supported hospital can "travel" to Dallas' homeless.
Parkland's vans are part of the tax-supported hospital's Homeless Outreach Medical Services, known as the HOMES program. They're equipped for X-ray screening for tuberculosis, dispensing medications and lab testing.
Last year, some 10,000 of Dallas' homeless received care in the vans, which cost about $175,000 annually to operate. The number of patients is expected to rise to 12,000 this year.
For public hospitals like Parkland, these mobile mini-clinics can deliver needed preventive healthcare that experts believe will reduce the number of costly emergency department visits later.
In Houston, the decision to operate a mobile clinic grew out of a community needs assessment done by the hospital.
Of the elderly residents screened since the van started operating in October, about a fourth were referred to a physician for follow-up treatment. In Athens, Ga., St. Mary's Health Express began its travels in 1991 for St. Mary's Hospital. The $99,000 clinic is a customized motor coach that includes a classroom, examination room, portable centrifuge for blood workups, refrigerator, computer, facsimile machine and cellular phone, two soundproof booths for hearing tests, toilet, sink, and wheelchair lift.
The classroom seats 10 persons-five on each side-and has a television set and videocassette recorder to play educational programs. A popular children's program is "Germbusters"-it teaches preschoolers about the importance of washing their hands to control the spread of germs.
The van makes its rounds from three to five times a week in the mostly rural 12-county area around Athens.
"Ninety percent of the things we do couldn't be done without (the mobile van)," said Ken McKinney, director of the hospital's community outreach services. "We go to a lot of schools, and those children couldn't be taken out of school."
For example, Health Express travels regularly to a school system about 25 miles away, where school district officials identified physical examinations as a priority need. Most of the children treated there are on Medicaid, Mr. McKinney said.
Although some hospitals' mobile units experience occasional mechanical problems, Mr. McKinney said that hasn't been a problem for Health Express. "We've never been off schedule more than one hour," he said.
To avoid problems down the line, vendors advise hospitals to seriously study what they want in the mobile clinic. Several companies renovate mobile clinics and know some of the common pitfalls.
"Most people think of an RV," said Bill Neff, a spokesman for the Mattman Co., an Escondido, Calif.-based firm that specializes in conversions of buses, trucks and trailers to mobile medical clinics. "That's a big `don't' because an RV is built to commercial specifications and it's easy to overload."
Because a mobile clinic typically has so much equipment, it's important to start with a heavy-duty chassis like that of a truck or a bus, he said.