UVA School of Medicine

region in a Volkswagen Beetle and started caring for patients where they were. While the nonprofit organization she started has expanded to include two stationary clinics, the mission of dispensing care from a mobile medical unit remains the core of the program. these days, Gardner, Bentley and Meade muscle a modified recreational vehicle through narrow country roads and mountainous terrain, bringing care to 11 remote communities on a weekly, biweekly and monthly basis. and while the program is always eager to accept donations, all of their services—including many medications—are provided free of charge. "the Health Wagon has tremendous cooperation from UVa," says smiddy, who graduated from the UVa school of Medicine in 1967. "there are pro- grams for the indigent that our patients can get into so they can travel to Charlottesville for major sur- gery or cancer treatment, and telemedicine is also an important part of what we do." Seeking opportunities to Provide Care the Center for telehealth is always looking for new opportunities to provide care. Using data provided by the Virginia Department of Health and in partnership with the Healthy appalachia institute at UVa-Wise, they survey health status indicators to identify areas of need across the Commonwealth and consider ways telemedicine might be leveraged to support those needs. that's how the UVa mobile mammography unit ended up going to Clinchco, Va., and other Health Wagon sites. Rheuban found that women in this Dickerson County town didn't have access to local screening mammography and weren't always will- ing or able to drive to Charlottesville to get it. and instead of just performing the procedure and bring- ing the images back to radiologists at the Medical "So much of health care is about forming relationships. Even with this high-tech capability, the desire at the center of it all is to really be able to see patients and care for them." – DaViD CatEll-GORDON DiRECtOR, UVa OFFiCE OF tElEMEDiCiNE UVa physicians for analysis through secure, HiPaa- compliant, password-protected channels. "through our telemedicine program, we are reaching more patients at the right time, with the right providers for the right reasons," Rheuban says. "We have helped to create a paradigm shift in care delivery." accessing Care in appalachia For people living in rural Virginia, access to health care is key. in the far southwestern counties of the state, however, finding providers and getting to care is only part of the problem. in the Health Wagon program, where 98 percent of patients are unin- sured and 70 percent earn less than $20,000 a year, despite working multiple jobs, it's poverty that pre- vents many people from accessing care. in this pocket of coal mining appalachia where chronic disease and lifestyle habits make this among the sickest regions of the country, people can't afford to even think about seeing a doctor. Preventative care, including dental care and routine screenings, is out of the question for many. and if they do get sick, these folks worry that the cost of an emergency room visit could bankrupt them. the Health Wagon was created as a way to bridge this health care gap. in 1980, sr. Bernie Kenny, a Catholic nun and nurse practitioner, rolled into the 16 Vitals Spring 2016

• Cover