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By Jasmin Singh
Sandy Scarborough was walking through a health fair last April when she came across a 39-foot white-and-blue Winnebago bus.
The bus drew attention as it sat in the middle of the fair in Kitty Hawk, hosted by the Outer Banks Hospital.
Beach visitors had puzzled looks on their faces, watching people come in and out of the bus.
“I was in awe,” she said.
The object of Scarborough’s awe was the Health Coach, a doctor’s office on wheels, covered in photos of sea shells, a bright-blue sky and a family enjoying the sun. The bus drives across Dare County and provides free medical screenings to both the insured and uninsured.
Amy Montgomery, director of outreach for Outer Banks Hospital, which launched the service in January 2014, said the goal of the coach is to provide access to basic care.
“We can actually take the vehicle straight to a place of business, a church, an organization, an event, and have the complete setup,” Montgomery said.
Scarborough, director of the Dare County Center, a multi-generational community center that provides programs to enhance quality of life and promote healthier lifestyles, said she first saw the Health Coach in action last year.
“They showed me everything on the bus and told me everything that they did, and that’s when I had my first screening,” Scarborough said. “Everyone was extremely friendly … really helpful and very professional.”
‘A mobile doctor’s office’
The coach operates like a regular doctor’s office.
“A wellness checkup can take up to 15 or 20 minutes because when they come on board they have their labs drawn, their blood pressure measured, their height, weight, all of those things,” said Denise DePedro, community relations coordinator for Outer Banks Hospital.
Scarborough said she was surprised at what she saw inside.
“I could not believe all of the stuff it had,” she said. “It’s a mobile doctor’s office. Everything that you need is there.”
Patients enter the bus and visit each of the workup stations. After going over their basic health history, they enter a private exam room where they can speak with a doctor privately.
The Health Coach offers cholesterol, glucose, blood pressure and body mass index measurements. Patients can also receive clinical breast exams and skin cancer screenings. In a regular office setting, these tests could cost around $300.
On the coach, they are free.
“You go to a doctor’s office and you’re paying a co-pay and you’re paying for all these services or your insurance is getting charged as well,” Scarborough said. “Here, you’re getting professional care for nothing.”
All of the health tests offered on the coach are free because of funding by The Outer Banks Hospital and the hospital’s development council.
Karla Coughenour, clinical outreach coordinator for the hospital, said if the physician is on board he or she works toward answering any questions the patient might have.
“If you have a concern about a certain area like on your skin, they’ll talk to you about screenings that you need,” Coughenour said. “They develop goals with them, whether it’s about the referral process, the start to exercise, the start to eat better.”
Scarborough said she appreciates the time she gets with the physician.
“When the doctor is there, not only do you get all of these free health screenings but you also get free one-on-one time with the doctor talking about your test results or anything else you want to talk to that doctor about,” she said.
DePedro said the coach provides a safe place for the patient and physician so they can talk about the importance of regular screenings.
“We’ve had dental problems identified, some skin cancers identified,” she said. “It’s a good opportunity for the provider to make referrals to other services.”
Not a replacement
Montgomery said the coach is only a place for screenings, not a replacement for traditional care.
“This vehicle doesn’t replace a primary care provider or the relationship between a patient and a doctor,” she said. “What it does do is that it makes it easy for people to get those basic wellness checkups.”
But with busy schedules and tight budgets, many individuals can’t afford to make it to their primary care physician to begin with, much less for follow up.
“If we identify anything, we always make sure they go right back to their primary care provider,” Montgomery said.
Sheila Davies, director of the public health division for the Dare County Department of Health and Human Services, said data collected from focus groups ranked access to primary care physicians as the third-biggest health problem in the county.
Davies said the coach does a good job in raising awareness for those who would have otherwise not realized that they had an illness.
“Anytime you can get in front of people, even if they didn’t have a primary care physician, that’s likely to contribute to driving population health improvement because you are getting people to think about it,” she said.
Davies said that though the Health Coach is an asset to the community, it is too soon to say whether it’s had a large enough impact on health outcomes.
“I think that in the short time that it has been in existence, it is incredibly well respected in the community and valued,” she said. “I think that it’s just too soon to have data to indicate its success or general outcome.”
A community as one
Montgomery said that one theme is repeated across the county: community support.
“If a problem is identified in Dare County, people gather and make a commitment to turn it around,” she said. “If someone identifies a place to improve, people just gather and [do] what is needed to be done to fix the problem or to improve the lives of people in our community.”
As of 2011, 15.7 percent of the county’s population did not have health insurance; 19.8 percent of adults ages 19 to 64 were uninsured.
Many workers in the area are low income: About a quarter of the county’s employees work in hotels and restaurants, making an average of $18,079 per year, earned mostly during warmer months. Another 18 percent work in retail, averaging $23,468 per year, according to Davies.
Many employers of such low-income workers don’t offer any kind of insurance coverage. But the number of workers drops dramatically in the off-season. July 2014 employment statistics found 26,630 workers compared to only 19,867 workers in Dare County in winter months.
For those uninsured individuals, Montgomery said, the coach provides pamphlets on how to sign up for insurance, gives them information about Medicaid programs and even provides directions to the local free clinic.
And to make sure everyone gets a chance on the bus, DePedro said there isn’t a place the coach can’t visit.
“We’ll go to businesses, like banks; we’ve been to churches, the homeless shelter and events,” she said. “Anywhere that has a parking lot, we just pull right up. Our goal is to do everything that we did last year, if not more.”