The Health Wagon Serves Up Care to Virginia’s Rural Uninsured

by Candi Helseth

Learn more about The Health Wagon in RHIhub’s Rural Health Models & Innovations.

Trundling along treacherous mountain roads, The Health Wagon visits geographically isolated areas in southwest Virginia’s Appalachian Mountains. Before the mobile clinic on wheels has even ground to a full stop, a line of people waits at the door. Last year, clinic staff and professional volunteers provided treatment for 2,647 of Virginia’s poorest residents. For free.

The Health Wagon

The Health Wagon provides medical care to uninsured residents in southwest Virginia.

“I just thank God for The Health Wagon,” says Celia Rice. “I’d been to the welfare office and the health department looking for help. But I couldn’t get help. When I finally saw the doctor after The Health Wagon got me help, he told me I would have had a heart attack and died.”

Rice, a lifelong Buchanan County resident, is among more than one million Virginians without health insurance. Buchanan, Dickenson and Russell counties, which are served by The Health Wagon, have high poverty rates.

“These are real people facing some unusual circumstances and diseases, and they need help but they can’t get it because they can’t afford it,” said Teresa Gardner, executive director of The Health Wagon.

Gardner is a family nurse practitioner and this year’s recipient of the American Academy of Nurse Practitioners State Award for Excellence. A 17-year veteran of The Health Wagon, Gardner says she and her staff—three nurses and two office workers—view their jobs as their mission. Gardner, who is completing a doctorate in nursing, provides comprehensive primary care for all the patients, diagnosing problems and prescribing medication as needed. The nurses follow up with health and lifestyle education.

“It’s hard work but we’re saving lives, changing lives, making a difference every day,” Gardner said.

Physicians and other professional staff who volunteer their time help fill the gaps in care. Dr. Tim McBride donates time to supervision, consultation, chart reviews and backup. Physician specialists provide services in acute needs areas, often giving more than professional expertise.

Take Dr. Joe Smiddy, a pulmonologist who practices in Kingsport, Tenn. Smiddy gets no pay but serves as The Health Wagon’s medical director, as well serving as a board member for the last seven years and as a physician seeing Health Wagon patients for the last nine years. He has participated in medical missions in Third World countries and says the patients he sees at The Health Wagon are just as needy.

The Appalachians have a multitude of health-related lung problems. Known as a coal mine belt, southwest Virginia has a high incidence of mine workers with lung disease. In addition, several area industries work with asbestos and histoplasmosis, a fungus in the soil, also causes lung disease, Smiddy said. Smoking and obesity rates are high.

“When we broke the numbers of smokers down by zip codes, we saw that the average age for starting to smoke was 12 in these areas,” Smiddy said. “By the time they’re in their early 30s, they already have 20 years accumulated in their lungs.”

Smiddy decided better X-ray technology was necessary to diagnose lung disease. So he purchased a high quality X-ray machine, tackled the legalities and insurance complexities involved with providing mobile X-rays, and then spent 180 hours in class and behind the wheel being trained to drive the truck that pulls the trailer carrying the X-ray equipment. Once they arrive, staff screen and X-ray patients and Smiddy sees every patient personally.

“We’ve done 2,200 free X-rays and we’ve found a lot of disease that wouldn’t have been diagnosed,” he said. “That’s about a $1,200 value if they had to go see a doctor for the same thing. And we carry donated medications if they need drugs.”

When fixing a patient’s problem is beyond their resources and their partnership relations, Health Wagon staff does whatever they can to get help for the patient. By the time Celia Rice found The Health Wagon, she said, “I’d been bleeding for two or three years and felt sick all the time.” Rice needed a hysterectomy. Health Wagon staff spent hours on the phone pleading Rice’s case until they found a surgeon who agreed to do the surgery.

Teresa Gardner

Teresa Gardner, a family nurse practitioner and executive director of The Health Wagon, examines Tyler, a young patient.

“These are good, praying people who really care about the people they see,” Rice said. “I’m here today because of The Health Wagon people.”

Gardner says her staff has become “very resourceful” when patients have to be referred for ongoing care. “We have partnerships with several areas that help us plug those patients into another point of care, but it is very time consuming and difficult. And there are a large number of patients that need more help than we are equipped to give. It breaks my heart when we have to turn a patient away or we can’t get them the help they need.”

Geographic isolation and cost barriers contribute to the likelihood that these patients are less likely to get the medical assistance they need, Smiddy said. “Even the ones that have insurance often can’t afford the co-pay or the medications that are prescribed. A lot of them don’t even know where they should go if they need help.”

Financial stressors plague the service. Fundraising is constant, Gardner said. Funding for the $440,000-a-year budget comes from private foundations and donations. Patients are not asked to pay for anything, although donations are welcomed.

Founded in 1980 by Sister Bernie Kenny, The Health Wagon received support from St. Mary’s Hospital until 2006 when a for-profit entity bought the hospital and dropped the clinic. Now The Health Wagon operates independently, but Gardner said various churches and faith-based organizations have been good to continue supporting it. Gardner and her team will continue to focus their efforts on the people that need them in southwest Virginia.

The Health Wagon has received the Virginia Governor’s Volunteerism and Community Service Award for Outstanding Nonprofit Group, the Virginia Rural Health Association‘s Best Practice Award, and the Award for Outstanding Devotion to the Community by the American Breast Cancer Foundation.

But the best reward, Gardner said, is their patients. Many, when asked who their doctor is, respond simply, “The Health Wagon.”

Back to: Summer 2009 Issue